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De Polo A, Buja A, Pasello G, Bortolami A, Zorzi M, Schiavon M, Marchetti M, Baldo V, Rugge M, Conte PF. Non–Small-Cell Lung Cancer: Real-World Cost Consequence Analysis. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The present work aimed at conducting a real-world data analysis on the management costs and survival analysis comparing data from non-small-cell lung cancer (NSCLC) cases diagnosed in the Veneto region before (2015) and after (2017) the implementation of a regional diagnostic and therapeutic pathway including all new diagnostic and therapeutic strategies.
Methods
This study considered 254 incidental cases of NSCLC in 2015 and 228 in 2017 within the territory of the Padua province (Italy), as recorded by the Veneto Cancer Registry. Tobit regression analysis was performed to verify if total and each item costs (2 years after NSCLC diagnosis) are associated with index year, adjusting by year of diagnosis, sex, age, and stage at diagnosis. Logistic regression models were run to study overall mortality at 2 years, adjusting by the same covariates.
Results
The 2017 cohort had a lower mortality odd (odds ratio, 0.93; P = .02) and a significant increase in the average overall costs (P = .009) than the 2015 cohort. The Tobit regression analysis by cost item showed a very significant increase in the average cost of drugs (coefficient = 5,953, P 5 .008) for the 2017 cohort, as well as a decrease in the average cost of hospice care (coefficient = -1,822.6, P = .022).
Conclusions
Our study showed a survival improvement for patients with NSCLC as well as an economic burden growth. Physicians should therefore be encouraged to follow new clinical care pathways, while the steadily rising related costs underscore the need for policymakers and health professionals to pursue the most rational utilization of public resources.
Key messages
Our work underscores the importance of real-world assessment of costs in oncology, especially in case of a disease like NSCLC, which has such a high impact on treatment costs and patient outcomes. New therapies prolong survival for patients with NSCLC but their sustainability reminds of the importance of prevention: the earlier the diagnosis, the longer the survival and the lower the costs.
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Affiliation(s)
- A De Polo
- Scuola di Specializzazione in Igiene, Medicina Preventiva e Sanità Pubblica, University of Padova, Padua, Italy
| | - A Buja
- Scuola di Specializzazione in Igiene, Medicina Preventiva e Sanità Pubblica, University of Padova, Padua, Italy
| | - G Pasello
- Oncologia Medica 2, Istituto Oncologico Veneto, I.R.C.C.S., Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - A Bortolami
- Rete Oncologica Veneta, Istituto Oncologico Veneto, I.R.C.C.S., Padua, Italy
| | - M Zorzi
- Veneto Tumor Registry, Azienda Zero, Padua, Italy
| | - M Schiavon
- Scuola di Specializzazione in Igiene, Medicina Preventiva e Sanità Pubblica, University of Padova, Padua, Italy
| | | | - V Baldo
- Scuola di Specializzazione in Igiene, Medicina Preventiva e Sanità Pubblica, University of Padova, Padua, Italy
| | - M Rugge
- Veneto Tumor Registry, Azienda Zero, Padua, Italy
| | - PF Conte
- Oncologia Medica 2, Istituto Oncologico Veneto, I.R.C.C.S., Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
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De Polo A, Facchin G, Battistin M, Pais Dei Mori L, Nassiz P, D'Alfonso M, Rizzardini J, Stevanato M, Zanghi F, Leone E, Cinquetti S. "Early" and "definitive" taking charge of subjects positive to SARS-CoV2: the experience of an Italian Local Health Authority. Ann Ig 2021; 34:202-205. [PMID: 34113954 DOI: 10.7416/ai.2021.2458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract During the second covid-19 pandemic wave in November-December 2021 Prevention Departments had to face a hardly-sustainable workload of contact tracing and taking charge of the sars-cov2 positive case and of his or her close contacts. Also laboratories have been stressed in their ability to process timely the extraordinary load of swabs performed. In this context of hazardous delays, the Prevention Department of Belluno (Italy) tested its resilience: a simple and effective method of taking charge was implemented, by initially phoning to the positive case and imposing the isolation measure on him or her and later on proceeding with the conventional contact tracing.
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Affiliation(s)
- A De Polo
- School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Italy.,Prevention Department, Local Health Authority "AULSS 1 Dolomiti", Belluno, Italy
| | - G Facchin
- School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Italy.,Prevention Department, Local Health Authority "AULSS 1 Dolomiti", Belluno, Italy
| | - M Battistin
- Prevention Department, Local Health Authority "AULSS 1 Dolomiti", Belluno, Italy
| | - L Pais Dei Mori
- Prevention Department, Local Health Authority "AULSS 1 Dolomiti", Belluno, Italy
| | - P Nassiz
- Prevention Department, Local Health Authority "AULSS 1 Dolomiti", Belluno, Italy
| | - M D'Alfonso
- Prevention Department, Local Health Authority "AULSS 1 Dolomiti", Belluno, Italy
| | - J Rizzardini
- Prevention Department, Local Health Authority "AULSS 1 Dolomiti", Belluno, Italy
| | - M Stevanato
- Prevention Department, Local Health Authority "AULSS 1 Dolomiti", Belluno, Italy
| | - F Zanghi
- Prevention Department, Local Health Authority "AULSS 1 Dolomiti", Belluno, Italy
| | - E Leone
- Prevention Department, Local Health Authority "AULSS 1 Dolomiti", Belluno, Italy
| | - S Cinquetti
- Prevention Department, Local Health Authority "AULSS 1 Dolomiti", Belluno, Italy
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De Luca G, Buja A, Rivera M, De Polo A, Marchetti M, Scioni M, Pasello G, Bortolami A, Schiavon M, Conte PF. Estimated direct costs of non-small-cell lung cancer by stage and care phase: a whole disease model. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Non-small-cell lung cancer (NSCLC) is the first cause of cancer-related death among men and the second among women worldwide. It also poses an economic threat to the sustainability of healthcare services. This study estimates the direct costs of care for patients with NSCLC by stage at diagnosis and management phase of pathway recommended in local and international guidelines.
Methods
Based on the most up-to-date guidelines we developed a detailed “whole-disease” model that lists the probabilities of all potentially necessary diagnostic and therapeutic actions involved in the management of each stage of NSCLC. Then we assigned the cost sustained by the public authorities to each procedure, obtaining an estimate of the total and average per-patient costs of each stage of the disease and management phase in Veneto Region, Italy.
Results
The mean expected cost of a patient with NSCLC is 22,968 € in the first year: 20,222 € in stage I, 23,935 € in stage II, 23,027 € in stage III, 22,915 € in stage IV and 31,749 € for Pancoast's tumors. In the second year the mean per patient-costs patient ranged from 2,722 €, for a patient with stage I disease, to 13,396 € for a patient with stage IV, with an overall average cost of 8,307 €. In the early stages, the main cost was due to surgery, whereas in the more advanced stages radiotherapy, medical therapy, treatment for progressions and supportive care become variously more important.
Conclusions
Our study enabled a prediction of the direct costs and outcomes for patients diagnosed with NSCLC on a two-year timeline after the diagnosis. An estimation of the direct costs of NSCLC, and in general for cancer, appears fundamental to predict the burden of new oncological therapies and treatments on healthcare services, and, in our opinion, our model could represent a useful tool for policy-makers in the optimization of resources allocation.
Key messages
Whole disease model allows an economic evaluation of a clinical pathway. The model is able to estimate direct costs of NSCLC by disease stage and management phase within a time horizon of two years. High cost-surgery makes the early stages no less expensive than advanced stages during the first year. In the second year, an advanced stage case costs almost five times more than an early stage case.
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Affiliation(s)
- G De Luca
- Dpartment of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - A Buja
- Dpartment of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Rivera
- Dpartment of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - A De Polo
- Dpartment of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Marchetti
- National Centre for Health Technology Assessment, National Institute of Health, Rome, Italy
| | - M Scioni
- Statistics Department, University of Padua, Padua, Italy
| | - G Pasello
- Department of Oncology, Veneto Institute of Oncology, Padua, Italy
| | - A Bortolami
- Department of Oncology, Veneto Institute of Oncology, Padua, Italy
| | - M Schiavon
- Dpartment of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - P F Conte
- Department of Oncology, Veneto Institute of Oncology, Padua, Italy
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Buja A, Rivera M, De Polo A, Zorzi M, Carpin E, Vecchiato A, Del Fiore P, Martin G, Saia M, Baldo V, Rugge M, Rossi C. Real‐world data for direct stage‐specific costs of melanoma healthcare. Br J Dermatol 2020; 183:171-172. [DOI: 10.1111/bjd.18896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A. Buja
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health University of Padova Padova Italy
| | - M. Rivera
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health University of Padova Padova Italy
| | - A. De Polo
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health University of Padova Padova Italy
| | - M. Zorzi
- Surgical Oncology Unit Veneto Institute of Oncology IOV‐IRCCS Veneto Italy
| | - E. Carpin
- Surgical Oncology Unit Veneto Institute of Oncology IOV‐IRCCS Veneto Italy
| | - A. Vecchiato
- Department of Surgery, Oncology and Gastroenterology University of Padova Padova Italy
| | - P. Del Fiore
- Department of Surgery, Oncology and Gastroenterology University of Padova Padova Italy
| | - G. Martin
- Surgical Oncology Unit Veneto Institute of Oncology IOV‐IRCCS Veneto Italy
| | - M. Saia
- Clinical Governance Unit Azienda Zero Veneto Regional Authority Veneto Italy
| | - V. Baldo
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health University of Padova Padova Italy
| | - M. Rugge
- Surgical Oncology Unit Veneto Institute of Oncology IOV‐IRCCS Veneto Italy
| | - C.R. Rossi
- Veneto Tumor Registry Azienda Zero Veneto Regional Authority Veneto Italy
- Department of Surgery, Oncology and Gastroenterology University of Padova Padova Italy
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