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Banegas MP, Hassett MJ, Keast EM, Carroll NM, O'Keeffe-Rosetti M, Fishman PA, Uno H, Hornbrook MC, Ritzwoller DP. Patterns of Medical Care Cost by Service Type for Patients With Recurrent and De Novo Advanced Cancer. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:69-76. [PMID: 35031101 DOI: 10.1016/j.jval.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/11/2021] [Accepted: 06/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES There is limited knowledge about the cost patterns of patients who receive a diagnosis of de novo and recurrent advanced cancers in the United States. METHODS Data on patients who received a diagnosis of de novo stage IV or recurrent breast, colorectal, or lung cancer between 2000 and 2012 from 3 integrated health systems were used to estimate average annual costs for total, ambulatory, inpatient, medication, and other services during (1) 12 months preceding de novo or recurrent diagnosis (preindex) and (2) diagnosis month through 11 months after (postindex), from the payer perspective. Generalized linear regression models estimated costs adjusting for patient and clinical factors. RESULTS Patients who developed a recurrence <1 year after their initial cancer diagnosis had significantly higher total costs in the preindex period than those with recurrence ≥1 year after initial diagnosis and those with de novo stage IV disease across all cancers (all P < .05). Patients with de novo stage IV breast and colorectal cancer had significantly higher total costs in the postindex period than patients with cancer recurrent in <1 year and ≥1 year (all P < .05), respectively. Patients in de novo stage IV and those with recurrence in ≥1 year experienced significantly higher postindex costs than the preindex period (all P < .001). CONCLUSIONS Our findings reveal distinct cost patterns between patients with de novo stage IV, recurrent <1-year, and recurrent ≥1-year cancer, suggesting unique care trajectories that may influence resource use and planning. Future cost studies among patients with advanced cancer should account for de novo versus recurrent diagnoses and timing of recurrence to obtain estimates that accurately reflect these care pattern complexities.
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Affiliation(s)
- Matthew P Banegas
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA; University of California San Diego, La Jolla, CA, USA.
| | | | - Erin M Keast
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Nikki M Carroll
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
| | | | - Paul A Fishman
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Hajime Uno
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Mark C Hornbrook
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
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Wolff HB, Alberts L, Kastelijn EA, El Sharouni SY, Schramel FMNH, Coupé VMH. Cost-Effectiveness of Surveillance Scanning Strategies after Curative Treatment of Non-Small-Cell Lung Cancer. Med Decis Making 2021; 41:153-164. [PMID: 33319646 PMCID: PMC7879224 DOI: 10.1177/0272989x20978167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/04/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND After curative treatment of primary non-small-cell lung cancer (NSCLC), patients undergo intensive surveillance with the aim to detect recurrences from the primary tumor or metachronous second primary lung cancer as early as possible and improve overall survival. However, the benefit of surveillance is debated. Available evidence is of low quality and conflicting. Microsimulation modeling facilitates the exploration of the impact of different surveillance strategies and provides insight into the cost-effectiveness of surveillance. METHODS A microsimulation model was used to simulate a range of computed tomography (CT)-based surveillance schedules, differing in the frequency and duration of CT surveillance. The impact on survival, quality-adjusted life-years, costs, and cost-effectiveness of each schedule was assessed. RESULTS Ten of 108 strategies formed the cost-effectiveness frontier; that is, these were the strategies with the optimal cost-health benefit balance. Per person, the discounted QALYs of these strategies varied between 5.72 and 5.81 y, and discounted costs varied between €9892 and €19,259. Below a willingness-to-pay threshold of €50,000/QALY, no scanning is the preferred option. For a willingness-to-pay threshold of €80,000/QALY, surveillance scanning every 2 y starting 1 y after curative treatment becomes the best option, with €11,860 discounted costs and 5.76 discounted QALYs per person. The European Society for Medical Oncology guideline strategy was more expensive and less effective than several other strategies. CONCLUSION Model simulations suggest that limited CT surveillance scanning after the treatment of primary NSCLC is cost-effective, but the incremental health-benefit remains marginal. However, model simulations do suggest that the guideline strategy is not cost-effective.
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Affiliation(s)
- Henri B. Wolff
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
| | - Leonie Alberts
- Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Sherif Y. El Sharouni
- Department of Radiotherapy, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Veerle M. H. Coupé
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
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Choi JW, Park EC. Suicide risk after cancer diagnosis among older adults: A nationwide retrospective cohort study. J Geriatr Oncol 2020; 11:814-819. [DOI: 10.1016/j.jgo.2019.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/09/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
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Pramesh CS, Chaturvedi H, Reddy VA, Saikia T, Ghoshal S, Pandit M, Babu KG, Ganpathy KV, Savant D, Mitera G, Sullivan R, Booth CM. Choosing Wisely India: ten low-value or harmful practices that should be avoided in cancer care. Lancet Oncol 2019; 20:e218-e223. [PMID: 30857957 DOI: 10.1016/s1470-2045(19)30092-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/14/2022]
Abstract
The Choosing Wisely India campaign was an initiative that was established to identify low-value or potentially harmful practices that are relevant to the Indian cancer health-care system. We undertook a multidisciplinary framework-driven consensus process to identify a list of low-value or harmful cancer practices that are frequently undertaken in India. A task force convened by the National Cancer Grid of India included Indian representatives from surgical, medical, and radiation oncology. Each specialty had representation from the private and public sectors. The task force included two representatives from national patient and patient advocacy groups. Of the ten practices that were identified, four are completely new recommendations, and six are revisions or adaptations from previous Choosing Wisely USA and Canada lists. Recommendations in the final list pertain to diagnosis and treatment (five practices), palliative care (two practices), imaging (two practices), and system-level delivery of care (two practices). Implementation of this list and reporting of concordance with its recommendations will facilitate the delivery of high-quality, value-based cancer care in India.
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Affiliation(s)
- C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
| | | | - Vijay Anand Reddy
- Department of Radiation Oncology, Apollo Hospitals, Hyderabad, India
| | - Tapan Saikia
- Department of Medical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Sushmita Ghoshal
- Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - K Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - K V Ganpathy
- Jeet Association for Support to Cancer Patients, Mumbai, India
| | | | - Gunita Mitera
- Department of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, and King's Health Partners Comprehensive Cancer Centre, London, UK
| | - Christopher M Booth
- Department of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
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Ritzwoller DP, Fishman PA, Banegas MP, Carroll NM, O'Keeffe‐Rosetti M, Cronin AM, Uno H, Hornbrook MC, Hassett MJ. Medical Care Costs for Recurrent versus De Novo Stage IV Cancer by Age at Diagnosis. Health Serv Res 2018; 53:5106-5128. [PMID: 30043542 PMCID: PMC6232408 DOI: 10.1111/1475-6773.13014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To address the knowledge gap regarding medical care costs for advanced cancer patients, we compared costs for recurrent versus de novo stage IV breast, colorectal, and lung cancer patients. DATA SOURCES/STUDY SETTING Virtual Data Warehouse (VDW) information from three Kaiser Permanente regions: Colorado, Northwest, and Washington. STUDY DESIGN We identified patients aged ≥21 with de novo or recurrent breast (nde novo = 352; nrecurrent = 765), colorectal (nde novo = 1,072; nrecurrent = 542), and lung (nde novo = 4,041; nrecurrent = 340) cancers diagnosed 2000-2012. We estimated average total monthly and annual costs in the 12 months preceding, month of, and 12 months following the index de novo/recurrence date, stratified by age at diagnosis (<65, ≥65). Generalized linear repeated-measures models controlled for demographics and comorbidity. PRINCIPAL FINDINGS In the pre-index period, monthly costs were higher for recurrent than for de novo breast (<65: +$2,431; ≥65: +$1,360), colorectal (<65: +$3,219; ≥65: +$2,247), and lung cancer (<65: +$3,086; ≥65: +$2,260) patients. Conversely, during the index and post-index periods, costs were higher for de novo patients. Average total annual pre-index costs were five- to ninefold higher for recurrent versus de novo patients <65. CONCLUSIONS Cost differences by type of advanced cancer and by age suggest heterogeneous patterns of care that merit further investigation.
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Affiliation(s)
| | - Paul A. Fishman
- Department of Health ServicesUniversity of WashingtonSeattleWA
- Kaiser Permanente Washington Health Research InstituteSeattleWA
| | | | | | | | | | - Hajime Uno
- Dana‐Farber Cancer InstituteBostonMA
- Harvard Medical SchoolBostonMA
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Deng W, Xu T, Xu Y, Wang Y, Liu X, Zhao Y, Yang P, Liao Z. Survival Patterns for Patients with Resected N2 Non-Small Cell Lung Cancer and Postoperative Radiotherapy: A Prognostic Scoring Model and Heat Map Approach. J Thorac Oncol 2018; 13:1968-1974. [PMID: 30194035 DOI: 10.1016/j.jtho.2018.08.2021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/21/2018] [Accepted: 08/27/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The positive-to-resected lymph node ratio (LNR) predicts survival in many cancers, but little information is available on its value for patients with N2 NSCLC who receive postoperative radiotherapy (PORT) after resection. We tested the applicability of prognostic scoring models and heat mapping to predict overall survival (OS) and cancer-specific survival (CSS) in patients with resected N2 NSCLC and PORT. METHODS Our test cohort comprised patients identified from the Surveillance, Epidemiology, and End Results database with N2 NSCLC who received resection and PORT in 2000-2014. Prognostic scoring models were developed to predict OS and CSS using Cox regression; heat maps were constructed with corresponding survival probabilities. Recursive partitioning analysis was applied to the Surveillance, Epidemiology, and End Results data to identify the optimal LNR cutoff point. Models and cutoff points were further tested in 183 similar patients treated at The University of Texas M. D. Anderson Cancer Center in 2000-2015. RESULTS Multivariate analyses revealed that low LNR independently predicted better OS and CSS in patients with resected N2 NSCLC who received PORT. CONCLUSIONS LNR can be used to predict survival of patients with resected N2 NSCLC followed by PORT. This approach, which to our knowledge is the first application of heat mapping of positive and negative lymph nodes, was effective in estimating 3-, 5-, and 10-year OS probabilities.
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Affiliation(s)
- Weiye Deng
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Ting Xu
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Yujin Xu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Gongshu District, Hanzhou, People's Republic of China
| | - Yifan Wang
- Department of Experimental Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Xiangyu Liu
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center, Houston, Texas
| | - Yu Zhao
- Department of Internal Medicine, Unity Hospital/Rochester Regional Health System, Rochester, New York
| | - Pei Yang
- Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
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Wang SM, Chang JC, Weng SC, Yeh MK, Lee CS. Risk of suicide within 1 year of cancer diagnosis. Int J Cancer 2018; 142:1986-1993. [PMID: 29250783 DOI: 10.1002/ijc.31224] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 11/26/2017] [Accepted: 12/04/2017] [Indexed: 12/29/2022]
Abstract
The association of the risk of suicide with cancer at different time points after a new cancer diagnosis is unclear. This study explored the suicide hazard at different time points after a first cancer diagnosis during the 1-year period before suicide. This case-crossover study included 2,907 suicide cases from 2002 to 2012 in Taiwan and compared the odds of suicide risk at different time points during one year after any cancer diagnosis with self-matched periods. The 13th month preceding the suicide date was used as the control period, and the hazard period was the duration from the 1st to 12th month in the conditional logistic regression for case-crossover comparisons. Among major groups of cancers, group of lip, oral cavity and pharynx cancers tended to have higher risk of suicide than other groups of cancers. The first month of cancer diagnosis was associated with the highest risk of suicide compared with the 13th month before suicide. The odds ratio (OR) of suicide were significantly in the first six months after cancer diagnosis but declined afterwards. For example, the adjusted OR was 3.47 [95% confidence interval (CI) = 2.60-4.62] in the first month and 1.53 (95% CI = 1.11-2.12) in the sixth month following cancer diagnosis. These findings provide clinicians with a vital reference period during which sufficient support and necessary referral to mental health support should be provided to reduce the risk of suicide among patients with newly diagnosed cancer morbidity.
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Affiliation(s)
- Shun-Mu Wang
- Department of Public Health, China Medical University, Taichung, Taiwan.,Department of Health Services Administration, China Medical University, Taichung, Taiwan.,Department of Biotechnology and Pharmaceutical Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Jung-Chen Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Chuan Weng
- Bachelor's Degree Program of Golden-Age Well-being Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Ming-Kung Yeh
- Graduate Institute of Medical Science and School of Pharmacy, National Defense Medical Center, Taiwan
| | - Chau-Shoun Lee
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
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Zaidi MY, Canter R, Cardona K. Post-operative surveillance in retroperitoneal soft tissue sarcoma: The importance of tumor histology in guiding strategy. J Surg Oncol 2017; 117:99-104. [DOI: 10.1002/jso.24927] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/31/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Mohammad Y. Zaidi
- Division of Surgical Oncology, Winship Cancer Institute; Emory University School of Medicine; Atlanta Georgia
| | - Robert Canter
- Division of Gastrointestinal Surgery and Surgical Oncology; UC Davis Comprehensive Cancer Center; Sacramento California
| | - Kenneth Cardona
- Division of Surgical Oncology, Winship Cancer Institute; Emory University School of Medicine; Atlanta Georgia
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Hernández Hernández JR. The Pulmonologist-Patient Relationship After the Lung Cancer Committee Decision. Arch Bronconeumol 2017; 54:179-180. [PMID: 28838745 DOI: 10.1016/j.arbres.2017.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 11/30/2022]
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