Cross-country comparisons of health-care costs: The case of cancer treatment in the Nordic countries

Association between adolescent obesity and early adulthood healthcare utilization-a two-cohort prospective study

BACKGROUND

Pediatric obesity is a growing global health challenge, with long-term implications for individuals and healthcare systems. Existing studies on the association between pediatric obesity and healthcare use in adulthood are limited and often rely on mathematical simulation models. This study aims to provide real-world data on the impact of adolescent obesity on specialized healthcare utilization and costs in early adulthood.

METHODS

This study analyzed data from two longitudinal cohorts: a population-based cohort from Norway (Young-HUNT) and a clinical cohort from Sweden (BORIS), the latter with matched general population comparators. Individuals included were born between 1987 and 1994, with BMI measurements at ages 13-19, and follow-up data from ages 20 to 30 years. Healthcare utilization and costs were assessed using national patient registries.

RESULTS

A total of 7592 individuals from Norway (5.7% with adolescent obesity) and 1543 individuals from Sweden with adolescent obesity, accompanied with 7330 matched general population comparators, were included. Among females, adolescent obesity was associated with significantly higher specialized healthcare utilization and costs in young adulthood, e.g., in Sweden, females with adolescent obesity had a 57% probability of annual specialized healthcare visits at ages 25-29, compared to 49% among the general population, p < 0.0001. In Norway, a similar pattern was observed. Among males, the association between obesity and healthcare utilization/annual specialized visits was less prominent. Annual excess costs for females with a history of adolescent obesity ranged from €578 to €835, while males showed minimal or no annual excess costs.

CONCLUSIONS

Analyses of real-world data cohorts from Norway and Sweden reveal that adolescent obesity is associated with increased healthcare utilization and costs in young adulthood, exceeding previous estimates. A distinct sex difference was evident, with females incurring higher costs compared to males.

Cancer-related costs should be allocated in a comparable way-benchmarking costs of cancer in Nordic countries 2012-2017

BACKGROUND

High costs of cancer, and especially the increase in treatment costs, have raised concerns about the financial sustainability of publicly funded health care systems around the world. As cancers get more prevalent with age, treatment costs are expected to keep rising with aging populations. The objective of the study is to analyze the changes in cost of cancer care broken down into separate cost components and outcomes of cancer treatment in the Nordic countries 2012-2017.

MATERIALS AND METHODS

We estimated direct costs of cancer based on retrospective data from national registers: outpatient care and inpatient care in primary care and specialized care as well as medicine costs. The number of cancer cases and survival data was obtained from NORDCAN. Cancer was defined as ICD-10 codes C00-C97.

RESULTS

Healthcare costs of cancer in real terms increased in all countries: CAGR was between 1 and 6% depending on the country. Medicine costs have increased rapidly (37-125%) in all countries during the observation period. In Finland and Denmark, inpatient care costs have decreased, whereas in Iceland, Norway, and Sweden, they have increased, although the number of inpatient days has decreased everywhere. The age-standardized cancer mortality has decreased constantly over time.

CONCLUSION

Cancer care in Nordic countries has significant differences in both cost structures and in the development of cost drivers, indicating differences in the organization of care and different focus in health policy. It is important to compare the cancer care costs internationally on a detailed level to understand the reasons for cost development. The registration of cost data, especially medicine costs, should be more standardized to enable better cost and outcomes comparisons between countries in the future.

The cost of illness and economic burden of endometriosis and chronic pelvic pain in Australia: A national online survey

Introduction

Endometriosis has a significant cost of illness burden in Europe, UK and the USA, with the majority of costs coming from reductions in productivity. However, information is scarce on if there is a differing impact between endometriosis and other causes of chronic pelvic pain, and if there are modifiable factors, such as pain severity, that may be significant contributors to the overall burden.

Methods

An online survey was hosted by SurveyMonkey and the link was active between February to April 2017. Women aged 18–45, currently living in Australia, who had either a confirmed diagnosis of endometriosis via laparoscopy or chronic pelvic pain without a diagnosis of endometriosis were included. The retrospective component of the WERF EndoCost tool was used to determine direct healthcare costs, direct non-healthcare costs (carers) and indirect costs due to productivity loss. Estimates were extrapolated to the Australian population using published prevalence estimates.

Results

407 valid responses were received. The cost of illness burden was significant in women with chronic pelvic pain (Int $16,970 to $ 20,898 per woman per year) irrespective of whether they had a diagnosis of endometriosis. The majority of costs (75–84%) were due to productivity loss. Both absolute and relative productivity costs in Australia were higher than previous estimates based on data from Europe, UK and USA. Pain scores showed the strongest relationship to productivity costs, a 12.5-fold increase in costs between minimal to severe pain. The total economic burden per year in Australia in the reproductive aged population (at 10% prevalence) was 6.50 billion Int $.

Conclusion

Similar to studies in European, British and American populations, productivity costs are the greatest contributor to overall costs. Given pain is the most significant contributor, priority should be given to improving pain control in women with pelvic pain

The indirect costs of palliative care in end-stage cancer: A real-life longitudinal register- and questionnaire-based study

BACKGROUND

Palliative care needs are increasing as more people are dying from incurable diseases. Healthcare costs have been reported to be highest during the last year of life, but studies on the actual costs of palliative care are scarce.

AIM

To explore the resource use and costs of palliative care among end-stage breast, colorectal and prostate cancer patients after termination of life-prolonging oncological treatments, that is, during the palliative care period.

DESIGN

A real-life longitudinal register- and questionnaire-based study of cancer patients' resource use and costs.

PARTICIPANTS

In total, 70 patients in palliative care with no ongoing oncological treatments were recruited from the Helsinki University Hospital or from the local hospice. Healthcare costs, productivity costs and informal care costs were included.

RESULTS

The mean duration of the palliative care period was 179 days. The healthcare cost accounted for 55%, informal care for 27% and productivity costs for 18% of the total costs. The last 2 weeks of life contributed to 37% of the healthcare cost. The costs of the palliative care period were higher in patients living alone, which was mostly caused by inpatient care ( p = 0.018).

CONCLUSION

The 45% share of indirect costs is substantial in end-of-life care. The healthcare costs increase towards death, which is especially true of patients living alone. This highlights the significant role of caregivers. More attention should be paid to home care and caregiver support to reduce inpatient care needs and control the costs of end-of-life care.

The relationship between post-operative time and cardiac autonomic modulation in breast cancer survivors

BACKGROUND/OBJECTIVES

Breast cancer survivors present autonomic dysfunction when evaluated by their heart rate variability (HRV). The purpose of this study is to investigate the relationship between post-operative time and cardiac autonomic modulation in breast cancer survivors and compare these values to those of women without cancer.

METHODS

This is a cross-sectional study consisting of 45 women from 35 to 70years old. These women were divided into two after breast cancer groups (BCG1 and BCG2) and a control group (CG). Group BCG1 consisted of women who had undergone breast cancer surgery within the last 18months and BCG2 those whose postoperative periods were more than 18months. The control group was formed by cancer-free women. HRV indices were used in the time and the frequency domain and geometric indexes.

RESULTS

The indices in millisecond, RMSSD (BCG1=19.83; BCG2=14.99; CG=31.46), SD1 (BCG1=14.03; BCG2=10.61; CG=22.27), SD2 (BCG1=39.17; BCG2=35.28; CG=61.16), SDNN (BCG1=29.58; BCG2=26.12; CG=46.36) and HF in milliseconds squared (BCG1=194.2; BCG2=91.07; CG=449.4) showed statistically significant reductions in the breast cancer groups compared to the CG (p≤0.0001). Lower SD1 index values were observed when comparing BCG2 to BCG1.

CONCLUSIONS

Breast cancer survivors regardless of their postoperative period exhibited a decrease in overall variability and both sympathetic and parasympathetic activity when compared to women without the disease. The group with the longer postoperative period manifested more pronounced autonomic modulation changes.

Secondary analysis of large databases for hepatology research

Secondary analysis of large datasets involves the utilization of existing data that has typically been collected for other purposes to advance scientific knowledge. This is an established methodology applied in health services research with the unique advantage of efficiently identifying relationships between predictor and outcome variables but which has been underutilized for hepatology research. Our review of 1431 abstracts published in the 2013 European Association for the Study of Liver (EASL) abstract book showed that less than 0.5% of published abstracts utilized secondary analysis of large database methodologies. This review paper describes existing large datasets that can be exploited for secondary analyses in liver disease research. It also suggests potential questions that could be addressed using these data warehouses and highlights the strengths and limitations of each dataset as described by authors that have previously used them. The overall goal is to bring these datasets to the attention of readers and ultimately encourage the consideration of secondary analysis of large database methodologies for the advancement of hepatology.

Cancer mortality reductions were greatest among countries where cancer care spending rose the most, 1995-2007

Health care spending and health outcomes vary markedly across countries, but the association between spending and outcomes remains unclear. This inevitably raises questions as to whether continuing growth in spending is justified, especially relative to the rising cost of cancer care. We compared cancer care across sixteen countries over time, examining changes in cancer spending and two measures of cancer mortality (amenable and excess mortality). We found that compared to low-spending health systems, high-spending systems had consistently lower cancer mortality in the period 1995-2007. Similarly, we found that the countries that increased spending the most had a 17 percent decrease in amenable mortality, compared to 8 percent in the countries with the lowest growth in cancer spending. For excess mortality, the corresponding decreases were 13 percent and 9 percent. Additionally, the rate of decrease for the countries with the highest spending growth was faster than the all-country trend. These findings are consistent with the existence of a link between higher cancer spending and lower cancer mortality. However, further work is needed to investigate the mechanisms that underlie this correlation.

Undesirable financial effects of head and neck cancer radiotherapy during the initial treatment period

BACKGROUND

Healthcare cost and reforms are at the forefront of international debates. One of the current discussion themes in oncology is whether and how patients' life changes due to costs of cancer care. In Norway, the main part of the treatment costs is supported by general taxpayer revenues.

OBJECTIVES

The objective of this study was to clarify whether head and neck cancer patients (n=67) in northern Norway experienced financial health-related quality of life (HRQOL) deterioration due to costs associated with treatment.

DESIGN

HRQOL was examined by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 in the beginning and in the end of radiation treatment in patients treated at the University Hospital in Northern Norway. Changes in financial HRQOL were calculated and compared by paired sample T-tests. Multiple regression analyses were used to examine correlations among gender, marital status, age and treatment with or without additional chemotherapy and changes in the HRQOL domain of financial difficulties.

RESULTS

The majority of score results at both time points were in the lower range (mean 15-25), indicating limited financial difficulties. We observed no statistically significant differences by gender, marital status and age. Increasing financial difficulties during treatment were reported by male patients and those younger than 65, that is, patients who were younger than retirement age. The largest effect was seen in singles. However, differences were not statistically significant.

CONCLUSIONS

During the initial phase of the disease trajectory, no significant increase in financial difficulties was found. This is in line with the aims of the Norwegian public healthcare model. However, long-term longitudinal studies should be performed, especially with regard to the trends we observed in single, male and younger patients.