Societal cost of cancer in Norway -Results of taking a broader cost perspective

Medical costs of treating myasthenia gravis in patients who need intravenous immunoglobulin (IVIg) - a register-based study

BACKGROUND

Several innovative treatments are expected for myasthenia gravis (MG) in the coming years. Healthcare payers usually require cost-effectiveness analyses before reimbursement. We aimed to investigate resource utilization and direct medical costs for patients with MG treated with intravenous immunoglobulin (IVIg) to inform such analyses.

METHODS

We identified patients with MG in the Norwegian Patient Registry based on at least two hospital encounters with an MG diagnosis (ICD-10 G70.0) from 1 Jan 2010 to 31 Dec 2021. IVIg treatment was identified by medical procedure and Anatomical Therapeutic Chemical (ATC) codes (RPGM05 and J06BA02). Using Diagnosis-Related Group (DRG) cost weights, we estimated direct medical costs for each year following the first MG diagnosis.

RESULTS

Over the study period, 1083 patients were diagnosed with MG in Norway, of whom 155 (14.3%) were treated with IVIg. No significant differences in age or sex were observed between IVIg and non-IVIg patients. Compared with non-IVIg patients, IVIg-patients had 2.3 times higher direct medical costs during the first year after MG diagnosis (EUR 35,714 vs. EUR 15,457) and 3.1 times higher costs during the second year (EUR 19,119 vs. EUR 6256). In the fifth year after diagnosis, IVIg-patients still had higher costs and resource utilization than non-IVIg patients (EUR 9953 vs. EUR 5634).

CONCLUSION

IVIg treatment represents an important marker for high direct medical costs among patients with MG. The costs continue to be high during the first five years after MG diagnosis.

Production losses from morbidity and mortality by disease, age and sex in Norway

AIM

The inclusion of production losses in health care priority setting is extensively debated. However, few studies allow for a comparison of these losses across relevant clinical and demographic categories. Our objective was to provide comprehensive estimates of Norwegian production losses from morbidity and mortality by age, sex and disease category.

METHODS

National registries, tax records, labour force surveys, household and population statistics and data from the Global Burden of Disease were combined to estimate production losses for 12 disease categories, 38 age and sex groups and four causes of production loss. The production losses were estimated via lost wages in accordance with a human capital approach for 2019.

RESULTS

The main causes of production losses in 2019 were mental and substance use disorders, totalling NOK121.6bn (32.7% of total production losses). This was followed by musculoskeletal disorders, neurological disorders, injuries, and neoplasms, which accounted for 25.2%, 7.4%, 7.4% and 6.5% of total production losses, respectively. Production losses due to sick leave, disability insurance and work assessment allowance were higher for females than for males, whereas production losses due to premature mortality were higher for males. The latter was related to neoplasms, cardiovascular disease and injuries. Across age categories, non-fatal conditions with a high prevalence among working populations caused the largest production losses.

CONCLUSIONS

The inclusion of production losses in health care priority debates in Norway could result in an emphasis on chronic diseases that occur among younger populations at the expense of fatal diseases among older age groups.

Onco@home: comparing the costs and reimbursement of cancer treatment at home with the standard of care

BACKGROUND

Oncological home hospitalization (HH) was implemented in a Belgian context to evaluate the feasibility of oncological HH. In a first HH model (HH1), implemented by three Belgian hospitals, two home nursing organizations and a grouping of independent nurses, the blood draw and monitoring prior to intravenous therapy was performed by a trained home nurse at the patient's home the day before the visit to the day hospital. In a second HH model (HH2), implemented in one hospital, the administration of two subcutaneous treatments (Azacitidine and Bortezomib) for myelodysplastic syndrome and multiple myeloma were provided at home instead of in the hospital. A previous study on this pilot showed that oncological HH is feasible and safe and improves the Quality of Life. The aim of this study is to investigate the cost and reimbursement of cancer treatment in these two HH models compared to the Standard of Care (SOC).

METHODS

A bottom-up micro-costing study was conducted to compare the costs and revenues for the providers (hospitals and home care organizations) of the SOC and the HH models.

RESULTS

Costs associated to HH were higher than the SOC in the hospital. Comparing revenues with costs, the research revealed that the reimbursement from the National Health Insurance of HH for oncological patients is insufficient. In HH1, costs were higher than in the SOC (+ €50.4). There was a reduction in costs in the hospital by moving the blood draw to the home setting (-€23.9), but the costs in home care were higher (+ €74.3). The extra revenues in home care (+ €33.6) were insufficient to cover the costs. The cost difference between the SOC and HH2 (+ €9.5 for Azacetidine) was smaller than in HH1. But, there was almost no funding for subcutaneous administration in home care. If the product is administered in a day hospital, the hospital receives a revenue of €124 per administration, while in home care the funding is €5 per visit.

CONCLUSION

Costs of HH are higher and the reimbursement from Belgian NHI is insufficient to organize HH. As a result, HH for oncology patient is still limited in Belgium.

The epidemiology and societal costs of myasthenia gravis in Norway: A non-interventional study using national registry data

BACKGROUND AND PURPOSE

With the emergence of new treatment options for myasthenia gravis (MG), there is a need for information regarding epidemiology, healthcare utilization, and societal costs to support economic evaluation and identify eligible patients. We aimed to enhance the understanding of these factors using nationwide systematic registry data in Norway.

METHODS

We received comprehensive national registry data from five Norwegian health- and work-related registries. The annual incidence and prevalence were estimated for the period 2013-2021 using nationwide hospital and prescription data. The direct, indirect (productivity losses) and intangible costs (value of lost life-years [LLY] and health-related quality of life [HRQoL]) related to MG were estimated over a period of 1 year.

RESULTS

In 2021, the incidence of MG ranged from 15 to 16 cases per year per million population depending on the registry used, while the prevalence varied between 208.9 and 210.3 per million population. The total annual societal costs of MG amounted to EUR 24,743 per patient, of which EUR 3592 (14.5%) were direct costs, EUR 8666 (35.0%) were productivity loss, and EUR 12,485 (50.5%) were lost value from LLY and reduced HRQoL.

CONCLUSION

The incidence and prevalence of MG are higher than previously estimated, and the total societal costs of MG are substantial. Our findings demonstrate that productivity losses, and the value of LLY and HRQoL constitute a considerable proportion of the total societal costs.

Evidence on bringing specialised care to the primary level-effects on the Quadruple Aim and cost-effectiveness: a systematic review

BACKGROUND

To achieve the Quadruple Aim of improving population health, enhancing the patient experience of care, reducing costs and improving professional satisfaction requires reorganisation of health care. One way to accomplish this aim is by integrating healthcare services on different levels. This systematic review aims to determine whether it is cost-effective to bring a hospital specialist into primary care from the perspectives of commissioners, patients and professionals.

METHODS

The review follows the PRISMA guidelines. We searched PubMed, Scopus and EBSCO (CINAHL and Academic Search Ultimate) for the period of 1992-2022. In total, 4254 articles were found, and 21 original articles that reported on both quality and costs, were included. The JBI and ROBINS-I tools were used for quality appraisal. In data synthesis, vote counting and effect direction plots were used together with a sign test. The strength of evidence was evaluated with the GRADE.

RESULTS

Cost-effectiveness was only measured in two studies, and it remains unclear. Costs and cost drivers for commissioners were lower in the intervention in 52% of the studies; this proportion rose to 67% of the studies when cost for patients was also considered, while health outcomes, patient experience and professional satisfaction mostly improved but at least remained the same. Costs for the patient, where measured, were mainly lower in the intervention group. Professional satisfaction was reported in 48% of the studies; in 80% it was higher in the intervention group. In 24% of the studies, higher monetary costs were reported for commissioners, whereas the clinical outcomes, patient experience and costs for the patient mainly improved.

CONCLUSIONS

The cost-effectiveness of the hospital specialist in primary care model remains inconclusive. Only a few studies have comprehensively calculated costs, evaluating cost drivers. However, it seems that when the service is well organised and the population is large enough, the concept can be profitable for the commissioner also. From the patient's perspective, the model is superior and could even promote equity through improved access. Professional satisfaction is mostly higher compared to the traditional model. The certainty of evidence is very low for cost and low for quality.

TRIAL REGISTRATION

PROSPERO CRD42022325232, 12.4.2022.

Heterogeneous trends of premature mortalities in Japan: joinpoint regression analysis of years of life lost from 2011 to 2019

Purpose

To assess long-term premature mortalities in Japan for providing evidence of strategies for sustainable development in population health.

Methods

Descriptive study for observing the trends of premature mortalities due to 10 major causes and all-cause in Japan was conducted using governmental statistics taken between 2011 and 2019. Years of life lost (YLL) was calculated for each cause, and the trends of these were examined by joinpoint regression analysis.

Results

The means of YLL for all-cause through 2011 to 2019 were 8,121,565.1 in males and 6,743,198.4 in females. For each cause, the trends of age-standardized YLL were downward except for malignant neoplasm of pancreas and heart failure in males, and malignant neoplasm of pancreas, malignant neoplasm of breast, and age-related physical debility in females. One significant joinpoint for heart failure was found in males, and one significant joinpoint for each of malignant neoplasm of pancreas and age-related physical debility were found in females.

Conclusions

Premature mortalities due to malignant neoplasm of pancreas in both sexes, heart failure in males and malignant neoplasm of breast in females were issues to be prioritized for promoting population health in Japan.

Determinants of exercise adherence and maintenance for cancer survivors: Implementation of a community-based group exercise program. A qualitative feasibility study

Objective

Despite verified knowledge that physical exercise plays an important part in recovery after cancer treatment, multiple studies have shown that maintaining a physically active lifestyle after cancer is challenging. There is a need for qualitative studies to increase understanding into patient experiences and perspectives, and facilitate the design of more sustainable exercise program. This qualitative descriptive feasibility study explores experiences from the implementation of a novel four-month community-based group exercise program for cancer survivors within municipality health service after completion of rehabilitation in the specialist health care service.

Methods

Fourteen cancer survivors participated in focus group interviews after completing Rehabilitation: Physical activity and Coping - feasibility study. Data were analyzed using the systematic text condensation method.

Results

We identified a main category, Determinants for exercise adherence and maintenance and four subcategories: peer-support, environment, structure and knowledge.

Conclusion

A social and supportive exercise environment promotes exercise adherence and maintenance among cancer survivors. This knowledge can be useful for further efforts to implement high quality community-based group exercise programs for cancer survivors.

Innovation

This study adds knowledge of survivors' experience of a novel community-based group exercise program in clinical practice and can promote the implementation of sustainable community-based exercise programs for cancer survivors.

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.

Long-term hospital resource utilization and associated costs of care for patients initiating nivolumab in advanced non-small cell lung cancer in France

OBJECTIVES

In advanced cancers, healthcare resource utilization (HCRU) and costs usually increase until death. However, few studies have measured HCRU over time in patients treated with immunotherapies. The objective was to describe the evolution of HCRU and costs over four years for patients with advanced non-small cell lung cancer (aNSCLC) initiating nivolumab.

MATERIALS AND METHODS

Based on the French hospital reimbursement database, all aNSCLC patients initiating nivolumab in the 2nd line or later in 2015 or 2016 were followed until 2019. HCRU (including hospitalizations and hospital visits) and costs (payer perspective) were described annually after nivolumab initiation. Trends in HCRU were analyzed with the Mann-Kendall test. As most patients did not reach the four-year follow-up, cost-analysis was performed without adjustment throughout, without adjustment in uncensored cases only or with adjustment using for all patients using the Bang&Tsiatis method.

RESULTS

10,452 patients initiating nivolumab were evaluated. The percentage of patients hospitalized or with hospital visits decreased (p < .001) over the four-year follow-up with the exception of consultations. The number of hospital visits per patient decreased from 23.3 in Y1 to 13.2 in Y4 without adjustment and 18.3 with adjustment (p < .001). The overall hospitalization duration per patient (days) decreased from 36.0 (Y1) to 14.9 (Y4-unadjusted) and 20.5 (Y4-adjusted) (p < .001). Annual per capita costs also decreased. The method without adjustment provided the lowest cost over time (€44,404 (Y1), €32,206 (Y2); €28,552 (Y3); €18,841(Y4)) while the Bang&Tsiatis method presented the highest cost (€45,002 (Y1), €36,330 (Y2); €35,080 (Y3); €28,931 (Y4)).

CONCLUSION

HCRU and costs for NSCLC patients treated with nivolumab decreased over time. Cost estimates are dependent on the statistical method used to take into account uncertainty, but costs decreased over time whatever the method used.

Phase- and gender-specific, lifetime, and future costs of cancer: A retrospective population-based registry study

Valid estimates of cancer treatment costs are import for priority setting, but few studies have examined costs of multiple cancers in the same setting.We performed a retrospective population-based registry study to evaluate phase-specific (initial, continuing, and terminal phase) direct medical costs and lifetime costs for 13 cancers and all cancers combined in Norway. Mean monthly cancer attributable costs were estimated using nationwide activity data from all Norwegian hospitals. Mean lifetime costs were estimated by combining phase-specific monthly costs and survival times from the national cancer registry. Scenarios for future costs were developed from the lifetime costs and the expected number of new cancer cases toward 2034 estimated by NORDCAN.For all cancers combined, mean discounted per patient direct medical costs were Euros (EUR) 21,808 in the initial 12 months, EUR 4347 in the subsequent continuing phase, and EUR 12,085 in the terminal phase (last 12 months). Lifetime costs were higher for cancers with a 5-year relative survival between 50% and 70% (myeloma: EUR 89,686, mouth/pharynx: EUR 66,619, and non-Hodgkin lymphoma: EUR 65,528). The scenario analyses indicate that future cancer costs are highly dependent on future cancer incidence, changes in death risk, and cancer-specific unit costs.Gender- and cancer-specific estimates of treatment costs are important for assessing equity of care and to better understand resource consumption associated with different cancers.Cancers with an intermediate prognosis (50%-70% 5-year relative survival) are associated with higher direct medical costs than those with relatively good or poor prognosis.