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Li W, Lu W, Chen H, Zhang C, Wang M, Zheng F, Wu HH, Wan GW, Yang Q, Ye L. Access to innovative anticancer medicines in China: a national survey on availability, price and affordability. BMJ Open 2024; 14:e077089. [PMID: 38670605 DOI: 10.1136/bmjopen-2023-077089] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES This study aimed to investigate the availability, price, and affordability of nationally negotiated innovative anticancer medicines in China. DESIGN Retrospective observational study based on data from a nationwide medical database. DATA SOURCES/SETTING Quarterly data about the use of innovative anticancer medicines from 2020 to 2022 were collected from the Chinese Medicine Economic Information Network. This study covered 895 public general hospitals in 30 provincial administrative regions in China. Of the total hospitals, 299 (33.41%) were secondary and 596 (66.59%) were tertiary. MAIN OUTCOME MEASURES The adjusted WHO and Health Action International methodology was used to calculate the availability and affordability of 33 nationally negotiated innovative anticancer medicines in the investigated hospitals. Price is expressed as the defined daily dose cost. RESULTS On average, the total availability of 33 innovative anticancer medicines increased annually from 2020 to 2022. The median availability of all investigated medicines in tertiary hospitals from 2020 to 2022 was 24.04%, 33.60% and 37.61%, respectively, while the indicators in secondary hospitals were 4.90%, 12.54% and 16.48%, respectively. The adjusted prices of the medicines newly put in Medicare (in March 2021) decreased noticeably, with the decline rate ranging from 39.98% to 82.45% in 2021 compared with those in 2020. Most generic brands were priced much lower than the originator brands. The affordability of anticancer medicines has improved year by year from 2020 to 2022. In comparison, rural residents had lower affordability than urban residents. CONCLUSIONS The overall accessibility of 33 nationally negotiated innovative anticancer medicines improved from 2020 to 2022. However, the overall availability of most anticancer medicines in China remained at a low level (less than 50%). Further efforts should be made to sufficiently and equally benefit patients with cancer.
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Affiliation(s)
- Wei Li
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wei Lu
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Hongdou Chen
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Chi Zhang
- Department of Nephrology, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Menglei Wang
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Fangfang Zheng
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Huan-Huan Wu
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Guang-Wen Wan
- Department of Pharmacy, Suqian Hospital of Traditional Chinese Medicine, Suqian, Jiangsu, China
| | - Qingqing Yang
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Lu Ye
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
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Beauchemin MP, Solomon S, Michaels CL, McHenry K, Turi E, Khurana R, Sanabria G. Toward identification and intervention to address financial toxicity and unmet health-related social needs among adolescents and emerging adults with cancer and their caregivers: A cross-cultural perspective. Cancer Med 2024; 13:e7197. [PMID: 38659403 PMCID: PMC11043682 DOI: 10.1002/cam4.7197] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE We qualitatively explored the unique needs and preferences for financial toxicity screening and interventions to address financial toxicity among adolescents and emerging adults (younger AYAs: 15-25 years) with cancer and their caregivers. METHODS We recruited English- or Spanish-speaking younger AYAs who were treated for cancer within the past 2 years and their caregivers. Semi-structured interviews were conducted to explore preferences for screening and interventional study development to address financial toxicity. The data were coded using conventional content analysis. Codes were reviewed with the study team, and interviews continued until saturation was reached; codes were consolidated into categories and themes during consensus discussions. RESULTS We interviewed 17 participants; nine were younger AYAs. Seven of the 17 preferred to speak Spanish. We identified three cross-cutting themes: burden, support, and routine, consistent, and clear. The burden came in the form of unexpected costs such as transportation to appointments, as well as emotional burdens such as AYAs worrying about how much their family sacrificed for their care or caregivers worrying about the AYA's physical and financial future. Support, in the form of familial, community, healthcare institution, and insurance, was critical to mitigating the effects of financial toxicity in this population. Participants emphasized the importance of meeting individual financial needs by routinely and consistently asking about financial factors and providing clear guidance to navigate these needs. CONCLUSION Younger AYAs and their caregivers experience significant financial challenges and unmet health-related social needs during cancer treatment and often rely on key supports to alleviate these unmet needs. When developing interventions to mitigate financial toxicity, clinicians and health systems should prioritize clear, consistent, and tailorable approaches to support younger AYA cancer survivors and their families.
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Affiliation(s)
- Melissa P. Beauchemin
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Herbert Irving Comprehensive Cancer CenterColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Samrawit Solomon
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Claudia L. Michaels
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Kathryn McHenry
- School of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Eleanor Turi
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Rhea Khurana
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
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Azzani M, Atroosh WM, Anbazhagan D, Kumarasamy V, Abdalla MMI. Describing financial toxicity among cancer patients in different income countries: a systematic review and meta-analysis. Front Public Health 2024; 11:1266533. [PMID: 38229668 PMCID: PMC10789858 DOI: 10.3389/fpubh.2023.1266533] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/17/2023] [Indexed: 01/18/2024] Open
Abstract
Background There is limited evidence of financial toxicity (FT) among cancer patients from countries of various income levels. Hence, this study aimed to determine the prevalence of objective and subjective FT and their measurements in relation to cancer treatment. Methods PubMed, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined FT. There was no limit on the design or setting of the study. Random-effects meta-analysis was utilized to obtain the pooled prevalence of objective FT. Results Out of 244 identified studies during the initial screening, only 64 studies were included in this review. The catastrophic health expenditure (CHE) method was often used in the included studies to determine the objective FT. The pooled prevalence of CHE was 47% (95% CI: 24.0-70.0) in middle- and high-income countries, and the highest percentage was noted in low-income countries (74.4%). A total of 30 studies focused on subjective FT, of which 9 used the Comprehensive Score for FT (COST) tool and reported median scores ranging between 17.0 and 31.9. Conclusion This study shows that cancer patients from various income-group countries experienced a significant financial burden during their treatment. It is imperative to conduct further studies on interventions and policies that can lower FT caused by cancer treatment.
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Affiliation(s)
- Meram Azzani
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Centre of Occupational Safety, Health and Wellbeing, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Wahib Mohammed Atroosh
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | - Deepa Anbazhagan
- Department of Microbiology, International Medical School (IMS), Management & Science University (MSU), Shah Alam, Selangor, Malaysia
| | - Vinoth Kumarasamy
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur, Malaysia
| | - Mona Mohamed Ibrahim Abdalla
- Physiology Department, Human Biology Division, School of Medicine, International Medical University (IMU), Kuala Lumpur, Malaysia
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Sahakyan Y, Li Q, Alibhai SM, Puts M, Yeretzian ST, Anwar MR, Brennenstuhl S, McLean B, Strohschein F, Tomlinson G, Wills A, Abrahamyan L. Cost-Utility Analysis of Geriatric Assessment and Management in Older Adults With Cancer: Economic Evaluation Within 5C Trial. J Clin Oncol 2024; 42:59-69. [PMID: 37871266 PMCID: PMC10730076 DOI: 10.1200/jco.23.00930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/31/2023] [Accepted: 08/22/2023] [Indexed: 10/25/2023] Open
Abstract
PURPOSE Geriatric assessment (GA) is a guideline-recommended approach to optimize cancer management in older adults. We conducted a cost-utility analysis alongside the 5C randomized controlled trial to compare GA and management (GAM) plus usual care (UC) against UC alone in older adults with cancer. METHODS The economic evaluation, conducted from societal and health care payer perspectives, used a 12-month time horizon. The Canadian 5C study randomly assigned patients to receive GAM or UC. Quality-adjusted life-years (QALYs) were measured using the EuroQol five dimension-5L questionnaire and health care utilization using cost diaries and chart reviews. We evaluated the incremental net monetary benefit (INMB) for the full sample and preselected subgroups. RESULTS A total of 350 patients were included, of whom 173 received GAM and 177 UC. At 12 months, the average QALYs per patient were 0.728 and 0.751 for GAM and UC, respectively (ΔQALY, -0.023 [95% CI, -0.076 to 0.028]). Considering a societal perspective, the total average costs (in 2021 Canadian dollars) per patient were $46,739 and $45,177 for GAM and UC, respectively (ΔCost, $1,563 [95% CI, -$6,583 to $10,403]). At a cost-effectiveness threshold of $50,000/QALY, GAM was not cost-effective compared with UC (INMB, -$2,713 [95% CI, -$11,767 to $5,801]). The INMB was positive ($2,984 [95% CI, -$7,050 to $14,179]; probability of being cost-effective, 72%) for patients treated with curative intent, but remained negative for patients treated with palliative intent (INMB, -$9,909 [95% CI, -$24,436 to $4,153]). Findings were similar considering a health care payer perspective. CONCLUSION To our knowledge, this is the first cost-utility analysis of GAM in cancer. GAM was cost-effective for patients with cancer treated with curative but not with palliative intent. The study provides further considerations for future adoption of GAM in practice.
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Affiliation(s)
- Yeva Sahakyan
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Qixuan Li
- Biostatistics Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M.H. Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shant T. Yeretzian
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Mohammed R. Anwar
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Bianca McLean
- Department of Medicine, Yale New Haven Hospital, New Haven, CT
| | - Fay Strohschein
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - George Tomlinson
- Biostatistics Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Aria Wills
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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Fine JR, Ransdell JM, Pinheiro PS, Kwon D, Reis IM, Barredo JC, Isrow DM. The Effect of Health Insurance on Pediatric Cancer Survival: An Analysis of Children Evaluated for Radiation Therapy in Diverse Multicenter Health Systems. J Pediatr Hematol Oncol 2023; 45:e662-e670. [PMID: 37278568 DOI: 10.1097/mph.0000000000002678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/21/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Understanding the role of health insurance in cancer survival in a diverse population of pediatric radiation oncology patients could help to identify patients at risk of adverse outcomes. MATERIALS AND METHODS Data were collected from cancer patients evaluated for radiation therapy, age < 19, diagnosed from January 1990 to August 2019. Predictors of recurrence-free survival (RFS) and overall survival (OS) were analyzed by univariable and multivariable Cox regression. Variables included health insurance, diagnosis type, sex, race/ethnicity, and socioeconomic status deprivation index. RESULTS The study included 459 patients with a median diagnosis age of 9 years. Demographic breakdown was 49.5% Hispanic, 27.2% non-Hispanic White, and 20.7% non-Hispanic Black. There were 203 recurrences and 86 deaths observed over a median follow-up of 2.4 years. Five-year RFS was 59.8% (95% CI, 51.6, 67.0) versus 36.5% (95% CI, 26.6, 46.6), and 5-year OS was 87.5% (95% CI, 80.9, 91.9) versus 71.0% (95% CI, 60.3, 79.3) in private pay insurance versus Medicaid/Medicare, respectively. Multivariable showed Medicaid/Medicare patients experienced a 54% higher risk of recurrence (hazard ratio: 1.54, 95% CI, 1.08, 2.20) and 79% higher risk of death (hazard ratio: 1.79, 95% CI, 1.02, 3.14) than privately insured patients. CONCLUSIONS Significant disadvantages in RFS and OS were identified in radiation oncology patients with Medicaid/Medicare insurance, even after adjusting for clinical and demographic variables.
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Affiliation(s)
| | | | - Paulo S Pinheiro
- Sylvester Comprehensive Cancer Center
- Department of Public Health Science, University of Miami Miller School of Medicine
| | - Deukwoo Kwon
- Division of Biostatistics, Department of Public Health Sciences, Miller School of Medicine, University of Miami
- Biostatistics and Bioinformatics Core Resource, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami
| | - Isildinha M Reis
- Division of Biostatistics, Department of Public Health Sciences, Miller School of Medicine, University of Miami
- Biostatistics and Bioinformatics Core Resource, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami
| | | | - Derek M Isrow
- Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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Qiu Z, Yao L, Jiang J. Financial toxicity assessment and associated factors analysis of patients with cancer in China. Support Care Cancer 2023; 31:264. [PMID: 37058171 PMCID: PMC10101818 DOI: 10.1007/s00520-023-07714-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/28/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE Cancer-related expenditures present a lasting economic burden on patients and their families and may exert long-term adverse effects on the patients' life and quality of life. In this study, the comprehensive score for financial toxicity (COST) was used to investigate the financial toxicity (FT) levels and related risk factors in Chinese patients with cancer. METHODS Quantitative data were collected through a questionnaire covering three aspects: sociodemographic information, economic and behavioral cost-coping strategies, and the COST scale. Univariate and multivariate analyses were performed to identify factors associated with FT. RESULTS According to 594 completed questionnaires, the COST score ranged 0-41, with a median of 18 (mean±SD, 17.98±7.978). Over 80% of patients with cancer reported at least moderate FT (COST score <26). A multivariate model showed that urban residents, coverage by other health insurance policies, and higher household income and consumption expenditures were significantly associated with higher COST scores, indicative of lower FT. The middle-aged (45-59 years old), higher out-of-pocket (OOP) medication expenditures and hospitalizations, borrowed money, and forgone treatment were all significantly associated with lower COST scores, indicating higher FT. CONCLUSION Severe FT was associated with sociodemographic factors among Chinese patients with cancer, family financial factors, and economic and behavioral cost-coping strategies. Government should identify and manage the patients with high-risk characteristics of FT and work out better health policies for them.
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Affiliation(s)
- Zenghui Qiu
- The School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lan Yao
- The School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junnan Jiang
- The School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
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Cell editorial team. Cancer: Untangling complexity together. Cell 2023; 186:1513-4. [PMID: 37059056 DOI: 10.1016/j.cell.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 03/18/2023] [Accepted: 03/18/2023] [Indexed: 04/16/2023]
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Kiros M, Memirie ST, Tolla MTT, Palm MT, Hailu D, Norheim OF. Cost-effectiveness of running a paediatric oncology unit in Ethiopia. BMJ Open 2023; 13:e068210. [PMID: 36918241 PMCID: PMC10016307 DOI: 10.1136/bmjopen-2022-068210] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE To estimate the cost-effectiveness of running a paediatric oncology unit in Ethiopia to inform the revision of the Ethiopia Essential Health Service Package (EEHSP), which ranks the treatment of childhood cancers at a low and medium priority. METHODS We built a decision analytical model-a decision tree-to estimate the cost-effectiveness of running a paediatric oncology unit compared with a do-nothing scenario (no paediatric oncology care) from a healthcare provider perspective. We used the recently (2018-2019) conducted costing estimate for running the paediatric oncology unit at Tikur Anbessa Specialized Hospital (TASH) and employed a mixed costing approach (top-down and bottom-up). We used data on health outcomes from other studies in similar settings to estimate the disability-adjusted life years (DALYs) averted of running a paediatric oncology unit compared with a do-nothing scenario over a lifetime horizon. Both costs and effects were discounted (3%) to the present value. The primary outcome was incremental cost in US dollars (USDs) per DALY averted, and we used a willingness-to-pay (WTP) threshold of 50% of the Ethiopian gross domestic product per capita (USD 477 in 2019). Uncertainty was tested using one-way and probabilistic sensitivity analyses. RESULTS The incremental cost and DALYs averted per child treated in the paediatric oncology unit at TASH were USD 876 and 2.4, respectively, compared with no paediatric oncology care. The incremental cost-effectiveness ratio of running a paediatric oncology unit was USD 361 per DALY averted, and it was cost-effective in 90% of 100 000 Monte Carlo iterations at a USD 477 WTP threshold. CONCLUSIONS The provision of paediatric cancer services using a specialised oncology unit is most likely cost-effective in Ethiopia, at least for easily treatable cancer types in centres with minimal to moderate capability. We recommend reassessing the priority-level decision of childhood cancer treatment in the current EEHSP.
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Affiliation(s)
- Mizan Kiros
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Solomon Tessema Memirie
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Addis Center for Ethics and Priority Setting, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Mieraf Taddesse Taddesse Tolla
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Michael Tekle Palm
- Department of Health Financing, Clinton Health Access Initiative, Addis Ababa, Ethiopia
| | - Daniel Hailu
- Department of Pediatrics and Child Health, Pediatric Hematology/Oncology Unit, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Ole F Norheim
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Su CT, Shankaran V. Defining the Role of the Modern Oncology Provider in Mitigating Financial Toxicity. J Am Coll Radiol 2023; 20:51-56. [PMID: 36513257 PMCID: PMC9898149 DOI: 10.1016/j.jacr.2022.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022]
Abstract
Financial toxicity, the cumulative financial hardships resulting from cancer diagnosis and treatment, is a growing problem in the United States. With the proliferation of costly novel therapeutics and improved cancer survival, financial toxicity will remain a major issue in cancer care delivery. Frontline oncology providers serve as gatekeepers in the medical system and, as such, could play essential roles in recognizing and addressing financial toxicity. Providers and health systems could help mitigate financial toxicity through routine financial toxicity screening, financial navigation, and advocacy. Specific strategies include developing and implementing financial screening instruments that can be integrated in electronic medical records and establishing team-based financial navigation programs to help patients with out-of-pocket medical costs, nonmedical spending, and insurance optimization. Finally, providers should continue to advocate for policies and legislation that decrease cost and promote value-based care. In this review, we examine opportunities for provider engagement in these areas and highlight gaps for future research.
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Affiliation(s)
- Christopher T Su
- Division of Hematology, University of Washington School of Medicine, Seattle, Washington; and Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Center, Seattle, Washington.
| | - Veena Shankaran
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington; and Codirector, Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Center, Seattle, Washington
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Cong Z, Tran O, Nelson J, Silver M, Chung K. Productivity Loss and Indirect Costs for Patients Newly Diagnosed with Early- versus Late-Stage Cancer in the USA: A Large-Scale Observational Research Study. Appl Health Econ Health Policy 2022; 20:845-856. [PMID: 36040661 PMCID: PMC9596506 DOI: 10.1007/s40258-022-00753-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The total economic burden of cancer reflects direct and indirect costs, including productivity loss due to employment change, absenteeism, and presenteeism of patients and caregivers. OBJECTIVE This study estimated the magnitude of employment decrease, work absence (WA), short-term disability (STD), long-term disability (LTD), and associated indirect costs among employees newly diagnosed with metastatic versus non-metastatic cancer in the USA. METHODS IBM® MarketScan® Commercial Claims and Encounters and Health and Productivity Management databases were used to identify employees aged 18-64 years and newly diagnosed with any cancer from 2009 to 2019. Proportions of patients with employment decrease, WA, STD, and LTD claims, and number of days missing from work were summarized by metastatic status during the first 12 months after diagnosis and the entire follow-up period. Subgroup analyses were conducted by age (< 50 years, ≥ 50 years) and cancer type (breast, lung, colon, pancreatic, and liver cancer). RESULTS During the first year after diagnosis, compared to patients without metastases, significantly higher proportions of patients with metastases had employment decrease and STD or LTD claims (p < 0.001). The mean total number of days missing from work for patients with versus without metastases was 33.39 versus 14.91 (ratio = 2.40), 64.05 versus 27.15 (ratio = 2.36), and 105.93 versus 46.29 (ratio = 2.29) days within 3, 6, and 12 months after diagnosis, respectively. Estimates of indirect cost differences between the two groups ranged from $6,877 to $22,283 in the first year. CONCLUSION Earlier detection of cancer may reduce productivity loss of patients and indirect costs by initiating treatment before cancer progresses to late stage.
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Affiliation(s)
- Ze Cong
- GRAIL, LLC, a subsidiary of Illumina, Inc., Menlo Park, CA, USA.
| | - Oth Tran
- Previously IBM Watson Health, San Francisco, USA
| | | | | | - Karen Chung
- GRAIL, LLC, a subsidiary of Illumina, Inc., Menlo Park, CA, USA
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Affiliation(s)
- Stacie B Dusetzina
- From the Department of Health Policy, Vanderbilt University School of Medicine, and the Vanderbilt-Ingram Cancer Center - both in Nashville
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Ortega-Ortega M, Hanly P, Pearce A, Soerjomataram I, Sharp L. Paid and unpaid productivity losses due to premature mortality from cancer in Europe in 2018. Int J Cancer 2022; 150:580-593. [PMID: 34569617 DOI: 10.1002/ijc.33826] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/15/2021] [Accepted: 09/06/2021] [Indexed: 12/24/2022]
Abstract
When someone dies prematurely from cancer this represents a loss of productivity for society. This loss can be valued and provides a measure of the cancer burden. We estimated paid and unpaid productivity lost due to cancer-related premature mortality in 31 European countries in 2018. Lost productivity was estimated for all cancers combined and 23 cancer sites, overall, by region and country. Deaths aged 15 to 64 were abstracted from GLOBOCAN 2018. Unpaid time lost (housework, caring, volunteering) was derived from Eurostat. Paid and unpaid productivity losses were valued using the human capital approach. In total, 347,149 premature cancer deaths occurred (60% male). The total value of cancer-related lost productivity was €104.6 billion. Of this, €52.9 billion (50.6%) was due to lost paid work, and €51.7 billion (49.4%) to unpaid work. Females accounted for 36.7% of paid work costs but half (51.1%) of the unpaid work costs. Costs were highest in Western Europe (€52.0 billion). The most costly cancer was lung (€21.7 billion), followed by breast (€10.6 billion). The average loss per premature death was highest for Hodgkin's lymphoma (€506 345), melanoma (€450 694), brain cancer (€428 449) and leukaemia (€378 750). Cancer-related lost productivity costs are significant. Almost half are due to unpaid work losses, indicating the importance of considering both paid and unpaid labour in assessing the cancer economic burden. The high cost per premature death of some less common cancers illustrates the potential benefits that could accrue from investment in prevention and control of these cancers.
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Affiliation(s)
- Marta Ortega-Ortega
- Department of Applied and Public Economics, and Political Economy, Complutense University of Madrid, Madrid, Spain
| | - Paul Hanly
- School of Business, National College of Ireland, Dublin 1, Ireland
| | - Alison Pearce
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | | | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle Upon Tyne, UK
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Giap F, Chino F. What Oncologists Must Account for: The Financial Burden of Cancer-Associated Symptom Relief. JCO Oncol Pract 2022; 18:106-108. [PMID: 34846913 PMCID: PMC9213193 DOI: 10.1200/op.21.00727] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023] Open
Affiliation(s)
- Fantine Giap
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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Fu SJ, Rose L, Dawes AJ, Knowlton LM, Ruddy KJ, Morris AM. Out-of-Pocket Costs Among Patients With a New Cancer Diagnosis Enrolled in High-Deductible Health Plans vs Traditional Insurance. JAMA Netw Open 2021; 4:e2134282. [PMID: 34935922 PMCID: PMC8696568 DOI: 10.1001/jamanetworkopen.2021.34282] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The financial burden of a cancer diagnosis is increasing rapidly with advances in cancer care. Simultaneously, more individuals are enrolling in high-deductible health plans (HDHPs) vs traditional insurance than ever before. OBJECTIVE To characterize the out-of-pocket costs (OOPCs) of cancer care for individuals in HDHPs vs traditional insurance plans. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used the administrative claims data of a single national insurer in the US for 134 826 patients aged 18 to 63 years with a new diagnosis of breast, colorectal, lung, or other cancer from 2008 to 2018 with 24 months or more of continuous enrollment. Propensity score matching was performed to create comparator groups based on the presence or absence of an incident cancer diagnosis. EXPOSURES A new cancer diagnosis and enrollment in an HDHP vs a traditional health insurance plan. MAIN OUTCOMES AND MEASURES The primary outcome was OOPCs among individuals with breast, colon, lung, or all other types of cancer combined compared with those with no cancer diagnosis. A triple difference-in-differences analysis was performed to identify incremental OOPCs based on cancer diagnosis and enrollment in HDHPs vs traditional plans. RESULTS After propensity score matching, 134 826 patients remained in each of the cancer (73 572 women [55%]; median age, 53 years [IQR, 46-58 years]; 110 071 non-Hispanic White individuals [82%]) and noncancer (66 619 women [49%]; median age, 53 years [IQR, 46-59 years]; 105 023 non-Hispanic White individuals [78%]) cohorts. Compared with baseline costs of medical care among individuals without cancer, a breast cancer diagnosis was associated with the highest incremental OOPC ($714.68; 95% CI, $664.91-$764.45), followed by lung ($475.51; 95% CI, $340.16-$610.86), colorectal ($361.41; 95% CI, $294.34-$428.48), and all other types of cancer combined ($90.51; 95% CI, $74.22-$106.79). Based on the triple difference-in-differences analysis, compared with patients without cancer enrolled in HDHPs, those with breast cancer paid $1683.36 in additional yearly OOPCs (95% CI, $1576.66-$1790.07), those with colorectal cancer paid $1420.06 more (95% CI, $1232.31-$1607.80), those with lung cancer paid $467.25 more (95% CI, $130.13-$804.37), and those with other types of cancer paid $550.87 more (95% CI, $514.75-$586.99). CONCLUSIONS AND RELEVANCE Patients with cancer and private insurance experienced sharp increases in OOPCs compared with those without cancer, which was amplified among those with HDHPs. These findings illustrate the degree to which HDHPs offer poorer protection than traditional insurance against unexpected health care expenses. Coupled with the increasing cost of cancer care, higher cost sharing in the form of increasing enrollment in HDHPs requires further research on the potential clinical consequences through delayed or foregone care.
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Affiliation(s)
- Sue J. Fu
- Stanford-Surgery Policy, Improvement Research, and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Liam Rose
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Aaron J. Dawes
- Stanford-Surgery Policy, Improvement Research, and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Lisa M. Knowlton
- Stanford-Surgery Policy, Improvement Research, and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | | | - Arden M. Morris
- Stanford-Surgery Policy, Improvement Research, and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
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Boby JM, Rajappa S, Mathew A. Financial toxicity in cancer care in India: a systematic review. Lancet Oncol 2021; 22:e541-e549. [PMID: 34856151 DOI: 10.1016/s1470-2045(21)00468-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/21/2022]
Abstract
Although financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and outcome among the Indian population. In this study, we systematically reviewed the prevalence, determinants, and consequences of financial toxicity among patients with cancer in India. 22 studies were included in the systematic review. The determinants of financial toxicity include household income, type of health-care facility used, stage of disease, area of residence, age at the time of diagnosis, recurrent cancer, educational status, insurance coverage, and treatment modality. Financial toxicity was associated with poor quality of life, accumulation of debts, premature entry into the labour market, and non-compliance with therapy. Our findings emphasise the need for urgent strategies to mitigate financial toxicity among patients with cancer in India, especially in the most deprived sections of society. The qualitative evidence synthesised in this systematic review could provide a basis for the development of such interventions to reduce financial toxicity among patients with cancer.
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Affiliation(s)
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Aju Mathew
- Malankara Orthodox Syrian Church Medical College, Kolenchery, India.
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Jane Bates M, Gordon MRP, Gordon SB, Tomeny EM, Muula AS, Davies H, Morris C, Manthalu G, Namisango E, Masamba L, Henrion MYR, MacPherson P, Squire SB, Niessen LW. Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study. Lancet Glob Health 2021; 9:e1750-e1757. [PMID: 34756183 PMCID: PMC8600125 DOI: 10.1016/s2214-109x(21)00408-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/09/2021] [Accepted: 08/27/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inclusive universal health coverage requires access to quality health care without financial barriers. Receipt of palliative care after advanced cancer diagnosis might reduce household poverty, but evidence from low-income and middle-income settings is sparse. METHODS In this prospective study, the primary objective was to investigate total household costs of cancer-related health care after a diagnosis of advanced cancer, with and without the receipt of palliative care. Households comprising patients and their unpaid family caregiver were recruited into a cohort study at Queen Elizabeth Central Hospital in Malawi, between Jan 16 and July 31, 2019. Costs of cancer-related health-care use (including palliative care) and health-related quality-of-life were recorded over 6 months. Regression analysis explored associations between receipt of palliative care and total household costs on health care as a proportion of household income. Catastrophic costs, defined as 20% or more of total household income, sale of assets and loans taken out (dissaving), and their association with palliative care were computed. FINDINGS We recruited 150 households. At 6 months, data from 89 (59%) of 150 households were available, comprising 89 patients (median age 50 years, 79% female) and 64 caregivers (median age 40 years, 73% female). Patients in 55 (37%) of the 150 households died and six (4%) were lost to follow-up. 19 (21%) of 89 households received palliative care. Catastrophic costs were experienced by nine (47%) of 19 households who received palliative care versus 48 (69%) of 70 households who did not (relative risk 0·69, 95% CI 0·42 to 1·14, p=0·109). Palliative care was associated with substantially reduced dissaving (median US$11, IQR 0 to 30 vs $34, 14 to 75; p=0·005). The mean difference in total household costs on cancer-related health care with receipt of palliative care was -36% (95% CI -94 to 594; p=0·707). INTERPRETATION Vulnerable households in low-income countries are subject to catastrophic health-related costs following a diagnosis of advanced cancer. Palliative care might result in reduced dissaving in these households. Further consideration of the economic benefits of palliative care is justified. FUNDING Wellcome Trust; National Institute for Health Research; and EMMS International.
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Affiliation(s)
- Maya Jane Bates
- Department of Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Miriam R P Gordon
- Department of Economics, Global Development Institute, University of Manchester, Manchester, UK
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi
| | - Ewan M Tomeny
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Adamson S Muula
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Helena Davies
- Worldwide Hospice Palliative Care Alliance, London, UK
| | - Claire Morris
- Worldwide Hospice Palliative Care Alliance, London, UK
| | - Gerald Manthalu
- Department of Planning, Ministry of Health, Lilongwe, Malawi
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Leo Masamba
- Department of Medicine, Queen Elizabeth Central Hospital, Ministry of Health, Blantyre, Malawi
| | - Marc Y R Henrion
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi
| | - Peter MacPherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi; London School of Hygiene & Tropical Medicine, London, UK
| | - S Bertel Squire
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Louis W Niessen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Johns Hopkins School of Public Health, Baltimore, MD, USA
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17
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Keating NL, Jhatakia S, Brooks GA, Tripp AS, Cintina I, Landrum MB, Zheng Q, Christian TJ, Glass R, Hsu VD, Kummet CM, Woodman S, Simon C, Hassol A. Association of Participation in the Oncology Care Model With Medicare Payments, Utilization, Care Delivery, and Quality Outcomes. JAMA 2021; 326:1829-1839. [PMID: 34751709 PMCID: PMC8579232 DOI: 10.1001/jama.2021.17642] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE In 2016, the US Centers for Medicare & Medicaid Services initiated the Oncology Care Model (OCM), an alternative payment model designed to improve the value of care delivered to Medicare beneficiaries with cancer. OBJECTIVE To assess the association of the OCM with changes in Medicare spending, utilization, quality, and patient experience during the OCM's first 3 years. DESIGN, SETTING, AND PARTICIPANTS Exploratory difference-in-differences study comparing care during 6-month chemotherapy episodes in OCM participating practices and propensity-matched comparison practices initiated before (January 2014 through June 2015) and after (July 2016 through December 2018) the start of the OCM. Participants included Medicare fee-for-service beneficiaries with cancer treated at these practices through June 2019. EXPOSURES OCM participation. MAIN OUTCOMES AND MEASURES Total episode payments (Medicare spending for Parts A, B, and D, not including monthly payments for enhanced oncology services); utilization and payments for hospitalizations, emergency department (ED) visits, office visits, chemotherapy, supportive care, and imaging; quality (chemotherapy-associated hospitalizations and ED visits, timely chemotherapy, end-of-life care, and survival); and patient experiences. RESULTS Among Medicare fee-for-service beneficiaries with cancer undergoing chemotherapy, 483 319 beneficiaries (mean age, 73.0 [SD, 8.7] years; 60.1% women; 987 332 episodes) were treated at 201 OCM participating practices, and 557 354 beneficiaries (mean age, 72.9 [SD, 9.0] years; 57.4% women; 1 122 597 episodes) were treated at 534 comparison practices. From the baseline period, total episode payments increased from $28 681 for OCM episodes and $28 421 for comparison episodes to $33 211 for OCM episodes and $33 249 for comparison episodes during the intervention period (difference in differences, -$297; 90% CI, -$504 to -$91), less than the mean $704 Monthly Enhanced Oncology Services payments. Relative decreases in total episode payments were primarily for Part B nonchemotherapy drug payments (difference in differences, -$145; 90% CI, -$218 to -$72), especially supportive care drugs (difference in differences, -$150; 90% CI, -$216 to -$84). The OCM was associated with statistically significant relative reductions in total episode payments among higher-risk episodes (difference in differences, -$503; 90% CI, -$802 to -$204) and statistically significant relative increases in total episode payments among lower-risk episodes (difference in differences, $151; 90% CI, $39-$264). The OCM was not significantly associated with differences in hospitalizations, ED visits, or survival. Of 22 measures of utilization, 10 measures of quality, and 7 measures of care experiences, only 5 were significantly different. CONCLUSIONS AND RELEVANCE In this exploratory analysis, the OCM was significantly associated with modest payment reductions during 6-month episodes for Medicare beneficiaries receiving chemotherapy for cancer in the first 3 years of the OCM that did not offset the monthly payments for enhanced oncology services. There were no statistically significant differences for most utilization, quality, and patient experience outcomes.
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Affiliation(s)
- Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | | | | | - Mary Beth Landrum
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Qing Zheng
- Abt Associates, Cambridge, Massachusetts
| | | | | | - Van Doren Hsu
- General Dynamics Information Technology, Falls Church, Virginia
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18
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Wang L, Du M, Cudhea F, Griecci C, Michaud DS, Mozaffarian D, Zhang FF. Disparities in Health and Economic Burdens of Cancer Attributable to Suboptimal Diet in the United States, 2015‒2018. Am J Public Health 2021; 111:2008-2018. [PMID: 34648383 PMCID: PMC8630501 DOI: 10.2105/ajph.2021.306475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To quantify disparities in health and economic burdens of cancer attributable to suboptimal diet among US adults. Methods. Using a probabilistic cohort state-transition model, we estimated the number of new cancer cases and cancer deaths, and economic costs of 15 diet-related cancers attributable to suboptimal intake of 7 dietary factors (a low intake of fruits, vegetables, dairy, and whole grains and a high intake of red and processed meats and sugar-sweetened beverages) among a closed cohort of US adults starting in 2017. Results. Suboptimal diet was estimated to contribute to 3.04 (95% uncertainty interval [UI] = 2.88, 3.20) million new cancer cases, 1.74 (95% UI = 1.65, 1.84) million cancer deaths, and $254 (95% UI = $242, $267) billion economic costs among US adults aged 20 years or older over a lifetime. Diet-attributable cancer burdens were higher among younger adults, men, non-Hispanic Blacks, and individuals with lower education and income attainments than other population subgroups. The largest disparities were for cancers attributable to high consumption of sugar-sweetened beverages and low consumption of whole grains. Conclusions. Suboptimal diet contributes to substantial disparities in health and economic burdens of cancer among young adults, men, racial/ethnic minorities, and socioeconomically disadvantaged groups. (Am J Public Health. 2021;111(11):2008-2018. https://doi.org/10.2105/AJPH.2021.306475).
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Affiliation(s)
- Lu Wang
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Mengxi Du
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Frederick Cudhea
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Christina Griecci
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Dominique S Michaud
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Dariush Mozaffarian
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Fang Fang Zhang
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
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Ebeid FSE, Ragab IA, Elsherif NHK, Makkeyah S, Mostafa S, Eltonbary K, Matbouly S, Mostafa A, Goma H, Agwa SH, Hafez HM, Girgis S, El Gendy YG, El-Sayed MH. COVID-19 in Children With Cancer: A Single Low-Middle Income Center Experience. J Pediatr Hematol Oncol 2021; 43:e1077-e1081. [PMID: 33290293 DOI: 10.1097/mph.0000000000002025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) could be associated with morbidity and mortality in immunocompromised children. OBJECTIVE The objective of this study was to measure the frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among hospitalized children with cancer and to detect the associated clinical manifestations and outcomes. METHODOLOGY A prospective noninterventional study including all hospitalized children with cancer conducted between mid-April and mid-June 2020 in Ain Shams University Hospital, Egypt. Clinical, laboratory, and radiologic data were collected. SARS-CoV-2 infection was diagnosed by reverse transcription polymerase chain reaction tests in nasopharyngeal swabs. RESULTS Fifteen of 61 hospitalized children with cancer were diagnosed with SARS-CoV-2. Their mean age was 8.3±3.5 years. Initially, 10 (66.7%) were asymptomatic and 5 (33.3%) were symptomatic with fever and/or cough. Baseline laboratory tests other than SARS-CoV-2 reverse transcription polymerase chain reaction were not diagnostic; the mean absolute lymphocyte count was 8.7±2.4×109/L. C-reactive protein was mildly elevated in most of the patients. Imaging was performed in 10 (66.7%) patients with significant radiologic findings detected in 4 (40%) patients. Treatment was mainly supportive with antibiotics as per the febrile neutropenia protocol and local Children Hospital guidance for management of COVID-19 in children. CONCLUSIONS Pediatric cancer patients with COVID-19 were mainly asymptomatic or with mild symptoms. A high index of suspicion and regular screening with nasopharyngeal swab in asymptomatic hospitalized cancer patients is recommended.
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Affiliation(s)
- Fatma S E Ebeid
- Pediatric Hematology Oncology Department
- Faculty of Medicine, Ain Shams University Research Institute-Clinical Research Center (MASRI-CRC)
| | | | | | | | | | | | | | - Aya Mostafa
- Community, Environmental, and Occupational Medicine
| | - Heba Goma
- Pediatric Hematology Oncology Department
| | | | | | | | | | - Manal H El-Sayed
- Pediatric Hematology Oncology Department
- Faculty of Medicine, Ain Shams University Research Institute-Clinical Research Center (MASRI-CRC)
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Zaorsky NG, Khunsriraksakul C, Acri SL, Liu DJ, Ba DM, Lin JL, Liu G, Segel JE, Drabick JJ, Mackley HB, Leslie DL. Medical Service Use and Charges for Cancer Care in 2018 for Privately Insured Patients Younger Than 65 Years in the US. JAMA Netw Open 2021; 4:e2127784. [PMID: 34613403 PMCID: PMC8495533 DOI: 10.1001/jamanetworkopen.2021.27784] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Currently, there are limited published data regarding resource use and spending on cancer care in the US. OBJECTIVE To characterize the most frequent medical services provided and the associated spending for privately insured patients with cancer in the US. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the MarketScan database for the calendar year 2018 from a sample of 27.1 million privately insured individuals, including patients with a diagnosis of the 15 most prevalent cancers, predominantly from large insurers and self-insured employers. Overall societal health care spending was estimated for each cancer type by multiplying the mean total spending per patient (estimated from MarketScan) by the number of privately insured patients living with that cancer in 2018, as reported by the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Analyses were performed from February 1, 2018, to July 8, 2021. EXPOSURES Evaluation and management as prescribed by treating care team. MAIN OUTCOMES AND MEASURES Current Procedural Terminology and Healthcare Common Procedure Coding System codes based on cancer diagnosis code. RESULTS The estimated cost of cancer care in 2018 for 402 115 patients with the 15 most prevalent cancer types was approximately $156.2 billion for privately insured adults younger than 65 years in the US. There were a total of 38.4 million documented procedure codes for 15 cancers in the MarketScan database, totaling $10.8 billion. Patients with breast cancer contributed the greatest total number of services (10.9 million [28.4%]), followed by those with colorectal cancer (3.9 million [10.2%]) and prostate cancer (3.6 million [9.4%]). Pathology and laboratory tests contributed the highest number of services performed (11.7 million [30.5%]), followed by medical services (6.3 million [16.4%]) and medical supplies and nonphysician services (6.1 million [15.9%]). The costliest cancers were those of the breast ($3.4 billion [31.5%]), followed by lung ($1.1 billion [10.2%]) and colorectum ($1.1 billion [10.2%]). Medical supplies and nonphysician services contributed the highest total spent ($4.0 billion [37.0%]), followed by radiology ($2.1 billion [19.4%]) and surgery ($1.8 billion [16.7%]). CONCLUSIONS AND RELEVANCE This analysis suggests that patients with breast, colorectal, and prostate cancers had the greatest number of services performed, particularly for pathology and laboratory tests, whereas patients with breast, lung, lymphoma, and colorectal cancer incurred the greatest costs, particularly for medical supplies and nonphysician services. The cost of cancer care in 2018 for the 15 most prevalent cancer types was estimated to be approximately $156.2 billion for privately insured adults younger than 65 years in the US.
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Affiliation(s)
- Nicholas G. Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Samantha L. Acri
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Dajiang J. Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Djibril M. Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - John L. Lin
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Joel E. Segel
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Health Policy and Administration, Pennsylvania State University, University Park
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Joseph J. Drabick
- Department of Medical Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Heath B. Mackley
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Radiation Oncology, Geisinger Health System, Danville, Pennsylvania
| | - Douglas L. Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Agarwal A, Livingstone A, Karikios DJ, Stockler MR, Beale PJ, Morton RL. Physician-patient communication of costs and financial burden of cancer and its treatment: a systematic review of clinical guidelines. BMC Cancer 2021; 21:1036. [PMID: 34530765 PMCID: PMC8447743 DOI: 10.1186/s12885-021-08697-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/17/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Optimising the care of individuals with cancer without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult. The American Society of Clinical Oncology (ASCO) has recommended clinicians discuss costs of cancer care with patients to enhance shared decision-making. We sought information to guide oncologists' discussions with patients about these costs. METHODS We searched Medline, EMBASE and clinical practice guideline databases from January 2009 to 1 June 2019 for recommendations about discussing the costs of care and financial burden. Guideline quality was assessed with the AGREE-II instrument. RESULTS Twenty-seven guidelines met our eligibility criteria, including 16 from ASCO (59%). 21 of 27 (78%) guidelines included recommendations about discussion or consideration of treatment costs when prescribing, with information about actual costs in four (15%). Recognition of the risk of financial burden or financial toxicity was described in 81% (22/27) of guidelines. However, only nine guidelines (33%) included information about managing the financial burden. CONCLUSIONS Current clinical practice guidelines have little information to guide physician-patient discussions about costs of anticancer treatment and management of financial burden. This limits patients' ability to control costs of treatment, and for the healthcare team to reduce the incidence and severity of financial burden. Current guidelines recommend clinician awareness of price variability and high costs of treatment. Clinicians are recommended to explore cost concerns and address financial worries, especially in high risk groups. Future guidelines should include advice on facilitating cost transparency discussions, with provision of cost information and resources.
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Affiliation(s)
- Anupriya Agarwal
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, 2050, Australia.
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.
| | - Ann Livingstone
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Deme J Karikios
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, 2050, Australia
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
- Nepean Cancer Centre, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Martin R Stockler
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, 2050, Australia
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Philip J Beale
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, 2050, Australia
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, 2050, Australia
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
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Albright BB, Chino F, Chino JP, Havrilesky LJ, Aviki EM, Moss HA. Associations of Insurance Churn and Catastrophic Health Expenditures With Implementation of the Affordable Care Act Among Nonelderly Patients With Cancer in the United States. JAMA Netw Open 2021; 4:e2124280. [PMID: 34495338 PMCID: PMC8427370 DOI: 10.1001/jamanetworkopen.2021.24280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Health insurance coverage is dynamic in the United States, potentially changing from month to month. The Patient Protection and Affordable Care Act (ACA) aimed to stabilize markets and reduce financial burden, particularly among those with preexisting conditions. OBJECTIVE To describe the risks of insurance churn (ie, gain, loss, or change in coverage) and catastrophic health expenditures among nonelderly patients with cancer in the United States, assessing for changes associated with ACA implementation. DESIGN, SETTING, AND PARTICIPANTS This retrospective, cross-sectional study uses data from the Medical Expenditure Panel Survey, a representative sample of the US population from 2005 to 2018. Respondents included were younger than 65 years, identified by health care use associated with a cancer diagnosis code in the given year. Statistical analysis was conducted from July 30, 2020, to January 5, 2021. EXPOSURES The Patient Protection and Affordable Care Act. MAIN OUTCOMES AND MEASURES Survey weights were applied to generate estimates for the US population. Annual risks of insurance churn (ie, any uninsurance or insurance change or loss) and catastrophic health expenditures (spending >10% income) were calculated, comparing subgroups with the adjusted Wald test. Weighted multivariable linear regression was used to assess for changes associated with ACA implementation. RESULTS From 6069 respondents, we estimated a weighted mean of 4.78 million nonelderly patients (95% CI, 4.55-5.01 million; female patients: weighted mean, 63.9% [95% CI, 62.2%-65.7%]; mean age, 50.3 years [95% CI, 49.7-50.8 years]) with cancer annually in the United States. Patients with cancer experienced lower annual risks of insurance loss (5.3% [95% CI, 4.5%-6.1%] vs 7.6% [95% CI, 7.4%-7.8%]) and any uninsurance (14.6% [95% CI, 13.3%-16.0%] vs 24.1% [95% CI, 23.5%-24.7%]) but increased risk of catastrophic health expenditures (expenses alone: 12.4% [95% CI, 11.2%-13.6%] vs 6.3% [95% CI, 6.2%-6.5%]; including premiums: 26.6% [95% CI, 25.0%-28.1%] vs 16.5% [95% CI, 16.1%-16.8%]; P < .001) relative to the population without cancer. Patients with cancer from low-income families and with full-year private coverage were at particularly high risk of catastrophic health expenditures (including premiums: 81.7% [95% CI, 74.6%-88.9%]). After adjustment, low income was the factor most strongly associated with both insurance churn and catastrophic spending, associated with annual risk increases of 6.5% (95% CI, 4.2%-8.8%) for insurance loss, 17.3% (95% CI, 13.4%-21.2%) for any uninsurance, and 37.4% (95% CI, 33.3%-41.6%) for catastrophic expenditures excluding premiums (P < .001). In adjusted models relative to 2005-2009, full ACA implementation (2014-2018) was associated with a decreased annual risk of any uninsurance (-4.2%; 95% CI, -7.4% to -1.0%; P = .01) and catastrophic spending by expenses alone (-3.0%; 95% CI, -5.3% to -0.8%; P = .008) but not including premiums (0.4%; 95% CI, -2.8% to 4.5%; P = .82). CONCLUSIONS AND RELEVANCE In this cross-sectional study, US patients with cancer faced significant annual risks of insurance churn and catastrophic health spending. Despite some improvements with ACA implementation, large burdens remained, and further reform is needed to protect this population from excessive hardship.
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Affiliation(s)
- Benjamin B. Albright
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Junzo P. Chino
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Laura J. Havrilesky
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Emeline M. Aviki
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Haley A. Moss
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
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Balasubramanian BA, Higashi RT, Rodriguez SA, Sadeghi N, Santini NO, Lee SC. Thematic Analysis of Challenges of Care Coordination for Underinsured and Uninsured Cancer Survivors With Chronic Conditions. JAMA Netw Open 2021; 4:e2119080. [PMID: 34387681 PMCID: PMC8363913 DOI: 10.1001/jamanetworkopen.2021.19080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE Although a majority of underinsured and uninsured patients with cancer have multiple comorbidities, many lack consistent connections with a primary care team to manage chronic conditions during and after cancer treatment. This presents a major challenge to delivering high-quality comprehensive and coordinated care. OBJECTIVE To describe challenges and opportunities for coordinating care in an integrated safety-net system for patients with both cancer and other chronic conditions. DESIGN, SETTING, AND PARTICIPANTS This multimodal qualitative study was conducted from May 2016 to July 2019 at a county-funded, vertically integrated safety-net health system including ambulatory oncology, urgent care, primary care, and specialty care. Participants were 93 health system stakeholders (clinicians, leaders, clinical, and administrative staff) strategically and snowball sampled for semistructured interviews and observation during meetings and daily processes of care. Data collection and analysis were conducted iteratively using a grounded theory approach, followed by systematic thematic analysis to organize data, review, and interpret comprehensive findings. Data were analyzed from March 2019 to March 2020. MAIN OUTCOMES AND MEASURES Multilevel factors associated with experiences of coordinating care for patients with cancer and chronic conditions among oncology and primary care stakeholders. RESULTS Among interviews and observation of 93 health system stakeholders, system-level factors identified as being associated with care coordination included challenges to accessing primary care, lack of communication between oncology and primary care clinicians, and leadership awareness of care coordination challenges. Clinician-level factors included unclear role delineation and lack of clinician knowledge and preparedness to manage the effects of cancer and chronic conditions. CONCLUSIONS AND RELEVANCE Primary care may play a critical role in delivering coordinated care for patients with cancer and chronic diseases. This study's findings suggest a need for care delivery strategies that bridge oncology and primary care by enhancing communication, better delineating roles and responsibilities across care teams, and improving clinician knowledge and preparedness to care for patients with cancer and chronic conditions. Expanding timely access to primary care is also key, albeit challenging in resource-limited safety-net settings.
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Affiliation(s)
- Bijal A. Balasubramanian
- University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Robin T. Higashi
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
- University of Texas Southwestern Medical Center, Dallas
| | | | - Navid Sadeghi
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
- University of Texas Southwestern Medical Center, Dallas
- Parkland Health and Hospital System, Dallas, Texas
| | | | - Simon Craddock Lee
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
- University of Texas Southwestern Medical Center, Dallas
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Takvorian SU, Yasaitis L, Liu M, Lee DJ, Werner RM, Bekelman JE. Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance. JAMA Netw Open 2021; 4:e2119764. [PMID: 34342648 PMCID: PMC8335573 DOI: 10.1001/jamanetworkopen.2021.19764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE With rising expenditures on cancer care outpacing other sectors of the US health system, national attention has focused on insurer spending, particularly for patients with private insurance, for whom price transparency has historically been lacking. The type of hospital at which cancer care is delivered may be an important factor associated with insurer spending for patients with private insurance. OBJECTIVE To examine differences in spending and utilization for patients with private insurance undergoing common cancer surgery at National Cancer Institute (NCI) centers vs community hospitals. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study included adult patients with an incident diagnosis of breast, colon, or lung cancer who underwent cancer-directed surgery from 2011 to 2014. Mean risk-adjusted spending and utilization outcomes were examined for each hospital type using multilevel generalized linear mixed-effects models, adjusting for patient, hospital, and region characteristics. Data were collected from the Health Care Cost Institute's national multipayer commercial claims data set, which encompasses claims paid by 3 of the 5 largest commercial health insurers in the United States (ie, Aetna, Humana, and UnitedHealthcare). Data analyses were conducted from February 2018 to February 2019. EXPOSURES Hospital type at which cancer surgery was performed: NCI, non-NCI academic, or community. MAIN OUTCOMES AND MEASURES Spending outcomes were surgery-specific insurer prices paid and 90-day postdischarge payments. Utilization outcomes were length of stay (LOS), emergency department (ED) use, and hospital readmission within 90 days of discharge. RESULTS The study included 66 878 patients (51 569 [77.1%] women; 31 585 [47.2%] aged ≥65 years) with incident breast (35 788 [53.5%]), colon (21 378 [32.0%]), or lung (9712 [14.5%]) cancer undergoing cancer surgery at 2995 hospitals (5522 [8.3%] at NCI centers; 10 917 [16.3%] at non-NCI academic hospitals; 50 439 [75.4%] at community hospitals). Treatment at NCI centers was associated with higher surgery-specific insurer prices paid compared with community hospitals ($18 526 [95% CI, $16 650-$20 403] vs $14 772 [95% CI, $14 339-$15 204]; difference, $3755 [95% CI, $1661-$5849]; P < .001) and 90-day postdischarge payments ($47 035 [95% CI, $43 289-$50 781] vs $41 291 [95% CI, $40 350-$42 231]; difference, $5744 [95% CI, $1659-9829]; P = .006). There were no significant differences in LOS, ED use, or hospital readmission within 90 days of discharge. CONCLUSIONS AND RELEVANCE In this cross-sectional study, surgery at NCI centers vs community hospitals was associated with higher insurer spending for a surgical episode without differences in care utilization among patients with private insurance undergoing cancer surgery. A better understanding of the factors associated with prices and spending at NCI cancer centers is needed.
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Affiliation(s)
- Samuel U. Takvorian
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Laura Yasaitis
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Manqing Liu
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel J. Lee
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel M. Werner
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Justin E. Bekelman
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Departments of Radiation Oncology and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Santacroce SJ, Killela MK, Kamkhoad D, Leckey JA, Hubbard G. He knew more than we wanted him to know: Parent perceptions about their children's sense of pediatric cancer-related financial problems. Pediatr Blood Cancer 2021; 68:e29080. [PMID: 33894050 PMCID: PMC10440629 DOI: 10.1002/pbc.29080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/16/2021] [Accepted: 04/05/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Treatment for pediatric cancer generates costs that place sizeable demands on family finances relative to household income. Little is known about whether children sense that their cancer has created financial problems for the family. The study purpose was to describe parents' perceptions about whether their child sensed that pediatric cancer created financial problems for their family. PROCEDURE Family Communications Theory informed our study. We used descriptive statistics and content analysis to examine parents' (n = 417) responses to questions about the child's sense of pediatric cancer-related financial problems from a larger survey study. RESULTS Approximately 56.2% of parents indicated that their child had no sense of the pediatric cancer-related financial problems and 44.1% indicated their child had some. Proportions of children perceived to sense these financial problems steadily increased with age grouping, while proportions perceived to have none declined. With content analysis, we identified cognitive capacity as the key child factor influencing children's sense of these problems. Influential context factors included social norms, observed changes in family routines and spending patterns, and overheard conversations between adults. Child psychological outcomes included guilt, anxiety about money, and feelings of being a burden. CONCLUSION Pediatric oncology professionals and staff should be mindful of parent preferences about burdening children with sensitive financial information, and modify their behaviors and processes accordingly. They can also provide anticipatory guidance and psycho-education about psychological responses related to the effects of pediatric cancer on family finances and the role of cognitive development in the evolution of children's awareness of those effects.
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Affiliation(s)
- Sheila Judge Santacroce
- School of Nursing, The University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill
| | - Mary K. Killela
- School of Nursing, The University of North Carolina at Chapel Hill
| | | | - Jill A. Leckey
- School of Nursing, The University of North Carolina at Chapel Hill
| | - Grace Hubbard
- School of Nursing, The University of North Carolina at Chapel Hill
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Niedermaier T, Gredner T, Kuznia S, Schöttker B, Mons U, Brenner H. Vitamin D supplementation to the older adult population in Germany has the cost-saving potential of preventing almost 30 000 cancer deaths per year. Mol Oncol 2021; 15:1986-1994. [PMID: 33540476 PMCID: PMC8333776 DOI: 10.1002/1878-0261.12924] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/09/2020] [Accepted: 02/02/2021] [Indexed: 12/14/2022] Open
Abstract
Recent meta-analyses of randomized controlled trials (RCTs) have demonstrated significant reduction in cancer mortality by vitamin D supplementation. We estimated costs and savings for preventing cancer deaths by vitamin D supplementation of the population aged 50+ years in Germany. Our analysis is based on national data on cancer mortality in 2016. The number of preventable cancer deaths was estimated by multiplying cancer deaths above age 50 with the estimated proportionate reduction in cancer mortality derived by vitamin D supplementation according to meta-analyses of RCTs (13%). Saved costs were estimated by multiplying this number by estimated end-of-life cancer care costs (€40 000). Annual costs of vitamin D supplementation were estimated at 25€ per person above age 50. Comprehensive sensitivity analyses were conducted. In the main analysis, vitamin D supplementation was estimated to prevent almost 30 000 cancer deaths per year at approximate costs of €900 million and savings of €1.154 billion, suggesting net savings of €254 million. Our results support promotion of supplementation of vitamin D among older adults as a cost-saving approach to substantially reduce cancer mortality.
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Affiliation(s)
- Tobias Niedermaier
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Thomas Gredner
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ)HeidelbergGermany
- Medical Faculty HeidelbergUniversity of HeidelbergGermany
| | - Sabine Kuznia
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ)HeidelbergGermany
- Medical Faculty HeidelbergUniversity of HeidelbergGermany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ)HeidelbergGermany
- Network Aging Research (NAR)University of HeidelbergGermany
| | - Ute Mons
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ)HeidelbergGermany
- Cancer Prevention UnitGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ)HeidelbergGermany
- Network Aging Research (NAR)University of HeidelbergGermany
- Division of Preventive OncologyGerman Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT)HeidelbergGermany
- German Cancer Consortium (DKTK)German Cancer Research Center (DKFZ)HeidelbergGermany
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Geethakumari PR, Ramasamy DP, Dholaria B, Berdeja J, Kansagra A. Balancing Quality, Cost, and Access During Delivery of Newer Cellular and Immunotherapy Treatments. Curr Hematol Malig Rep 2021; 16:345-356. [PMID: 34089485 PMCID: PMC8179081 DOI: 10.1007/s11899-021-00635-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The chimeric antigen receptor (CAR) T-cell therapy is currently changing the landscape of hematologic malignancies with multiple FDA-approved cell therapy products in the USA. The current administration process of the CAR T-cell therapy is complicated, labor-intensive, and expensive. RECENT FINDINGS The chimeric antigen receptor (CAR) T-cell therapy is currently changing the landscape of hematologic malignancies with multiple FDA-approved cell therapy products in the USA. The current administration process of the CAR T-cell therapy is complicated, labor-intensive, and expensive. This review article addresses the present-day challenges and discusses opportunities to optimize the access and affordability of the CAR T-cell therapy. The field of cellular immunotherapy is going to change the future of solid tumors and non-oncological diseases. However, this promising therapy poses challenges in the administration and management of quality in the current field of healthcare. We describe various novel approaches to manage challenges in improving access and improving widescale implementation of cellular therapies.
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Affiliation(s)
| | - Dheepthi Perumal Ramasamy
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX, 76034, USA
| | | | - Jesús Berdeja
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN, USA
| | - Ankit Kansagra
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX, 76034, USA.
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Bugge C, Brustugun OT, Sæther EM, Kristiansen IS. Phase- and gender-specific, lifetime, and future costs of cancer: A retrospective population-based registry study. Medicine (Baltimore) 2021; 100:e26523. [PMID: 34190187 PMCID: PMC8257845 DOI: 10.1097/md.0000000000026523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 06/04/2021] [Indexed: 01/04/2023] Open
Abstract
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.
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Affiliation(s)
- Christoffer Bugge
- Department of Health Management and Health Economics, University of Oslo
- Oslo Economics, Oslo
| | - Odd Terje Brustugun
- Section of Oncology, Drammen Hospital, Vestre Viken Health Trust, Drammen, Norway
| | | | - Ivar Sønbø Kristiansen
- Department of Health Management and Health Economics, University of Oslo
- Oslo Economics, Oslo
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
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King MT, Norman R, Mercieca-Bebber R, Costa DSJ, McTaggart-Cowan H, Peacock S, Janda M, Müller F, Viney R, Pickard AS, Cella D. The Functional Assessment of Cancer Therapy Eight Dimension (FACT-8D), a Multi-Attribute Utility Instrument Derived From the Cancer-Specific FACT-General (FACT-G) Quality of Life Questionnaire: Development and Australian Value Set. Value Health 2021; 24:862-873. [PMID: 34119085 DOI: 10.1016/j.jval.2021.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 12/14/2020] [Accepted: 01/04/2021] [Indexed: 05/19/2023]
Abstract
OBJECTIVES To develop a cancer-specific multi-attribute utility instrument derived from the Functional Assessment of Cancer Therapy - General (FACT-G) health-related quality of life (HRQL) questionnaire. METHODS We derived a descriptive system based on a subset of the 27-item FACT-G. Item selection was informed by psychometric analyses of existing FACT-G data (n = 6912) and by patient input (n = 82). We then conducted an online valuation survey, with participants recruited via an Australian general population online panel. A discrete choice experiment (DCE) was used, with attributes being the HRQL dimensions of the descriptive system and survival duration, and 16 choice-pairs per participant. Utility decrements were estimated with conditional logit and mixed logit modeling. RESULTS Eight HRQL dimensions were included in the descriptive system: pain, fatigue, nausea, sleep, work, social support, sadness, and future health worry; each with 5 levels. Of 1737 panel members who accessed the valuation survey, 1644 (95%) completed 1 or more DCE choice-pairs and were included in analyses. Utility decrements were generally monotonic; within each dimension, poorer HRQL levels generally had larger utility decrements. The largest utility decrements were for the highest levels of pain (-0.40) and nausea (-0.28). The worst health state had a utility of -0.54, considerably worse than dead. CONCLUSIONS A descriptive system and preference-based scoring approach were developed for the FACT-8D, a new cancer-specific multi-attribute utility instrument derived from the FACT-G. The Australian value set is the first of a series of country-specific value sets planned that can facilitate cost-utility analyses based on items from the FACT-G and related FACIT questionnaires containing FACT-G items.
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Affiliation(s)
- Madeleine T King
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia.
| | - Richard Norman
- Curtin University - Perth City Campus, and Department of Health Policy and Management, Bentley Campus, Perth, ACT, Australia
| | - Rebecca Mercieca-Bebber
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia; The University of Sydney, Faculty of Medicine and Health, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Daniel S J Costa
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia; Pain Management Research Institute, Saint Leonards, NSW, Australia and The University of Sydney, Sydney Medical School, Sydney, NSW, Australia
| | - Helen McTaggart-Cowan
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada and British Columbia Cancer Agency, Vancouver, BC, Canada; Simon Fraser University, Faculty of Health Sciences, Burnaby, BC, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada and British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Monika Janda
- Queensland University of Technology, School of Public Health, Institute of Health and Biomedical Innovation, Brisbane, QLD, Australia
| | - Fabiola Müller
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia; Amsterdam University Medical Centres, Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, NL
| | - Rosalie Viney
- University of Technology Sydney, Centre for Health Economics Research and Evaluation, Sydney, NSW, Australia
| | - Alan Simon Pickard
- University of Illinois at Chicago, Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA
| | - David Cella
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, IL, USA
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Salsman JM, Danhauer SC, Moore JB, Ip EH, McLouth LE, Nightingale CL, Cheung CK, Bingen K, Tucker-Seeley RD, Little-Greene D, Howard DS, Reeve BB. Systematic review of financial burden assessment in cancer: Evaluation of measures and utility among adolescents and young adults and caregivers. Cancer 2021; 127:1739-1748. [PMID: 33849081 PMCID: PMC8113116 DOI: 10.1002/cncr.33559] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 11/06/2022]
Abstract
The cost of cancer care is rising and represents a stressor that has significant and lasting effects on quality of life for many patients and caregivers. Adolescents and young adults (AYAs) with cancer are particularly vulnerable. Financial burden measures exist but have varying evidence for their validity and reliability. The goal of this systematic review is to summarize and evaluate measures of financial burden in cancer and describe their potential utility among AYAs and their caregivers. To this end, the authors searched PubMed, Embase, the Cochrane Library, CINAHL, and PsycINFO for concepts involving financial burden, cancer, and self-reported questionnaires and limited the results to the English language. They discarded meeting abstracts, editorials, letters, and case reports. The authors used standard screening and evaluation procedures for selecting and coding studies, including consensus-based standards for documenting measurement properties and study quality. In all, they screened 7250 abstracts and 720 full-text articles to identify relevant articles on financial burden. Eighty-six articles met the inclusion criteria. Data extraction revealed 64 unique measures for assessing financial burden across material, psychosocial, or behavioral domains. One measure was developed specifically for AYAs, and none were developed for their caregivers. The psychometric evidence and study qualities revealed mixed evidence of methodological rigor. In conclusion, several measures assess the financial burden of cancer. Measures were primarily designed and evaluated in adult patient populations with little focus on AYAs or caregivers despite their increased risk of financial burden. These findings highlight opportunities to adapt and test existing measures of financial burden for AYAs and their caregivers.
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Affiliation(s)
| | | | | | - Edward H. Ip
- Wake Forest School of Medicine, Winston Salem, NC
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Longo CJ, Fitch MI, Loree JM, Carlson LE, Turner D, Cheung WY, Gopaul D, Ellis J, Ringash J, Mathews M, Wright J, Stevens C, D'Souza D, Urquhart R, Maity T, Balderrama F, Haddad E. Patient and family financial burden associated with cancer treatment in Canada: a national study. Support Care Cancer 2021; 29:3377-3386. [PMID: 33403399 PMCID: PMC8062343 DOI: 10.1007/s00520-020-05907-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 11/19/2020] [Indexed: 11/01/2022]
Abstract
GOAL To determine patient-reported financial and family burden associated with treatment of cancer in the previous 28 days across Canada. METHODS A self-administered questionnaire (P-SAFE v7.2.4) was completed by 901 patients with cancer from twenty cancer centres nationally (344 breast, 183 colorectal, 158 lung, 216 prostate) measuring direct and indirect costs related to cancer treatment and foregone care. Monthly self-reported out-of-pocket-costs (OOPCs) included drugs, homecare, homemaking, complementary/ alternative medicines, vitamins/supplements, family care, accommodations, devices, and "other" costs. Travel and parking costs were captured separately. Patients indicated if OOPC, travel, parking, and lost income were a financial burden. RESULTS Mean 28-day OOPCs were CA$518 (US Purchase Price Parity [PPP] $416), plus CA$179 (US PPP $144) for travel and CA$84 (US PPP $67) for parking. Patients self-reporting high financial burden had total OOPCs (33%), of CA$961 (US PPP $772), while low-burden participants (66%) had OOPCs of CA$300 (US PPP $241). "Worst burden" respondents spent a mean of 50.7% of their monthly income on OOPCs (median 20.8%). Among the 29.4% who took time off work, patients averaged 18.0 days off. Among the 26.0% of patients whose caregivers took time off work, caregivers averaged 11.5 days off. Lastly, 41% of all patients had to reduce spending. Fifty-two per cent of those who reduced spending were families earning < CA$50,000/year. CONCLUSIONS In our Canadian sample, high levels of financial burden exist for 33% of patients, and the severity of burden is higher for those with lower household incomes.
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Affiliation(s)
- Christopher J Longo
- DeGroote School of Business-Health Policy & Management, McMaster University, 4350 South Service Rd, Burlington, Ontario, L7L 5R8, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, M4C 4V9, Canada
| | - Jonathan M Loree
- Department of Medicine, Division of Medical Oncology, BC Cancer / University of British Columbia, 600 West 10th Avenue, Vancouver, British Columbia, V5Z4E6, Canada
| | - Linda E Carlson
- Department of Oncology, Cummings School of Medicine, University of Calgary, 2202 2nd St SW, Calgary, Alberta, T2S 3C1, Canada
| | - Donna Turner
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 675 McDermot Avenue, Winnipeg, MB, R3E 0V9, Canada
| | - Winson Y Cheung
- Department of Oncology, University of Calgary, 1331-29 Street NW, Calgary, Alberta, T2N 4N2, Canada
| | - Darin Gopaul
- Grand River Regional Cancer Centre, Kitchener, Ontario, N2G 1G3, Canada
| | - Janet Ellis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jolie Ringash
- Princess Margaret Cancer Centre/UHN, 610 University Ave, Toronto, Ontario, M5G 2M9, Canada
| | - Maria Mathews
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Jim Wright
- Juravinski Cancer Centre, McMaster University, Hamilton, Canada
| | - Christiaan Stevens
- Department of Radiation Oncology, University of Toronto, Barrie, Ontario, L4M 6M2, Canada
| | - David D'Souza
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Room 8-032, Centennial Building, 1276 South Park St., Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Tuhin Maity
- DeGroote School of Business-Health Policy & Management, McMaster University, 4350 South Service Rd, Burlington, Ontario, L7L 5R8, Canada
| | - Fanor Balderrama
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Evette Haddad
- DeGroote School of Business-Health Policy & Management, McMaster University, 4350 South Service Rd, Burlington, Ontario, L7L 5R8, Canada
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Printz C. Price transparency still an issue for cancer center costs. Cancer 2021; 126:2733. [PMID: 32441796 DOI: 10.1002/cncr.32974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND Cost-related medication underuse (CRMU) has been reported within the general population in Canada. In this study, we assessed patterns of CRMU among Canadian adults with cancer. METHODS This is a cross-sectional study using survey data. We accessed data sets from the 2015/16 Canadian Community Health Survey (CCHS) and reviewed the records of adults (≥ 18 yr) with a history of cancer who were prescribed medication in the previous 12 months. We collected information about sociodemographic features, health behaviours and CRMU, and conducted a multivariable logistic regression analysis for factors associated with CRMU. RESULTS A total of 8581 participants were eligible for the current study. In the weighted multivariable logistic regression analysis, the following factors were associated with CRMU: younger age (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.79-3.63), female sex (male sex v. female sex OR 0.62, 95% CI 0.44-0.88), Indigenous racial background (Indigenous v. White OR 2.37, 95% CI 1.49- 3.77), unmarried status (OR 1.59, 95% CI 1.09-2.30), poor self-perceived health (excellent v. poor self-perceived health OR 0.36, 95% CI 0.17-0.77), lower annual income (< $20 000 v. income ≥ $80 000 OR 3.08, 95% CI 1.75-5.41) and lack of insurance for prescription medications (OR 2.49, 95% CI 1.77-3.50). INTERPRETATION The toll of CRMU among adults seems to be unequally carried by women, racial minorities, and younger (< 65 yr) and uninsured patients with cancer. Discussion about a national pharmacare program for people without private insurance is needed.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alta.
| | - Scott North
- Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alta
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Tai TA, Latimer NR, Benedict Á, Kiss Z, Nikolaou A. Prevalence of Immature Survival Data for Anti-Cancer Drugs Presented to the National Institute for Health and Care Excellence and Impact on Decision Making. Value Health 2021; 24:505-512. [PMID: 33840428 DOI: 10.1016/j.jval.2020.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 09/18/2020] [Accepted: 10/18/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This research aims to explore how often the National Institute for Health and Care Excellence (NICE) uses immature overall survival data to inform reimbursement decisions on cancer treatments, and the implications of this for resource allocation decisions. METHODS NICE cancer technology appraisals published between 2015 and 2017 were reviewed to determine the prevalence of using immature survival data. A case study was used to demonstrate the potential impact of basing decisions on immature data. The economic model submitted by the company was reconstructed and was populated first using survival data available at the time of the appraisal, and then using data from an updated data cut published after the appraisal concluded. The incremental cost-effectiveness ratios (ICERs) obtained using the different data cuts were compared. Probabilistic sensitivity analysis was undertaken and expected value of perfect information estimated. RESULTS Forty-one percent of NICE cancer technology appraisals used immature data to inform reimbursement decisions. In the case study, NICE gave a positive recommendation for a limited patient subgroup, with ICERs too high in the complete patient population. ICERs were dramatically lower when the final data cut was used, irrespective of the parametric model used to model survival. Probabilistic sensitivity analysis and expected value of perfect information may not have fully characterized uncertainty, because as they did not account for structural uncertainty. CONCLUSION Analyses of cancer treatments using immature survival data may result in incorrect estimates of survival benefit and cost-effectiveness, potentially leading to inappropriate funding decisions. This research highlights the importance of revisiting past decisions when updated data cuts become available.
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Affiliation(s)
- Ting-An Tai
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
| | - Nicholas R Latimer
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | | | - Zsofia Kiss
- Modelling and Simulation, Evidera, London, England, UK
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Saxena A, Rubens M, Ramamoorthy V, Tonse R, Veledar E, McGranaghan P, Sundil S, Chuong MD, Hall MD, Odia Y, Mehta MP, Kotecha R. Hospitalization rates for complications due to systemic therapy in the United States. Sci Rep 2021; 11:7385. [PMID: 33795827 PMCID: PMC8016938 DOI: 10.1038/s41598-021-86911-x] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/22/2021] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to estimate the trends and burdens associated with systemic therapy-related hospitalizations, using nationally representative data. National Inpatient Sample data from 2005 to 2016 was used to identify systemic therapy-related complications using ICD-9 and ICD-10 external causes-of-injury codes. The primary outcome was hospitalization rates, while secondary outcomes were cost and in-hospital mortality. Overall, there were 443,222,223 hospitalizations during the study period, of which 2,419,722 were due to complications of systemic therapy. The average annual percentage change of these hospitalizations was 8.1%, compared to - 0.5% for general hospitalizations. The three most common causes for hospitalization were anemia (12.8%), neutropenia (10.8%), and sepsis (7.8%). Hospitalization rates had the highest relative increases for sepsis (1.9-fold) and acute kidney injury (1.6-fold), and the highest relative decrease for dehydration (0.21-fold) and fever of unknown origin (0.35-fold). Complications with the highest total charges were anemia ($4.6 billion), neutropenia ($3.0 billion), and sepsis ($2.5 billion). The leading causes of in-hospital mortality associated with systemic therapy were sepsis (15.8%), pneumonia (7.6%), and acute kidney injury (7.0%). Promoting initiatives such as rule OP-35, improving access to and providing coordinated care, developing systems leading to early identification and management of symptoms, and expanding urgent care access, can decrease these hospitalizations and the burden they carry on the healthcare system.
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Affiliation(s)
- Anshul Saxena
- Baptist Health South Florida, Miami, FL, USA
- Florida International University, Miami, FL, USA
| | - Muni Rubens
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | | | - Raees Tonse
- Baptist Health South Florida, Miami, FL, USA
| | - Emir Veledar
- Baptist Health South Florida, Miami, FL, USA
- Florida International University, Miami, FL, USA
| | - Peter McGranaghan
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Subrina Sundil
- Southeastern Regional Medical Center, Lumberton, NC, USA
| | - Michael D Chuong
- Florida International University, Miami, FL, USA
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Matthew D Hall
- Florida International University, Miami, FL, USA
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Yazmin Odia
- Florida International University, Miami, FL, USA
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Minesh P Mehta
- Florida International University, Miami, FL, USA
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Rupesh Kotecha
- Florida International University, Miami, FL, USA.
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
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Du M, Griecci CF, Cudhea FF, Eom H, Kim DD, Wilde P, Wong JB, Wang YC, Michaud DS, Mozaffarian D, Zhang F. Cost-effectiveness Analysis of Nutrition Facts Added-Sugar Labeling and Obesity-Associated Cancer Rates in the US. JAMA Netw Open 2021; 4:e217501. [PMID: 33904914 PMCID: PMC8080223 DOI: 10.1001/jamanetworkopen.2021.7501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/05/2021] [Indexed: 11/18/2022] Open
Abstract
Importance Obesity-associated cancer burdens are increasing in the US. Nutrition policies, such as the Nutrition Facts added-sugar labeling, may reduce obesity-associated cancer rates. Objective To evaluate the cost-effectiveness of Nutrition Facts added-sugar labeling and obesity-associated cancer rates in the US. Design, Setting, and Participants A probabilistic cohort state-transition model was used to conduct an economic evaluation of added-sugar labeling and 13 obesity-associated cancers among 235 million adults aged 20 years or older by age, sex, and race/ethnicity over a median follow-up of 34.4 years. Policy associations were considered in 2 scenarios: with consumer behaviors and with additional industry reformulation. The model integrated nationally representative population demographics, diet, and cancer statistics; associations of policy intervention with diet, diet change and body mass index, and body mass index with cancer risk; and policy and health-related costs from established sources. Data were analyzed from January 8, 2019, to May 6, 2020. Main Outcomes and Measures Net costs and incremental cost-effectiveness ratio were estimated from societal and health care perspectives. Probabilistic sensitivity analyses incorporated uncertainty in input parameters and generated 95% uncertainty intervals (UIs). Results Based on consumer behaviors, the policy was associated with a reduction of 30 000 (95% UI, 21 600-39 300) new cancer cases and 17 100 (95% UI, 12 400-22 700) cancer deaths, a gain of 116 000 (95% UI, 83 800-153 000) quality-adjusted life-years, and a saving of $1600 million (95% UI, $1190 million-$2030 million) in medical costs associated with cancer care among US adults over a lifetime. The policy was associated with a savings of $704 million (95% UI, $44.5 million-$1450 million) from the societal perspective and $1590 million (95% UI, $1180 million-$2020 million) from the health care perspective. Additional industry reformulation to reduce added-sugar amounts in packaged foods and beverages would double the impact. Greater health gains and cost savings were expected among young adults, women, and non-Hispanic Black individuals than other population subgroups. Conclusions and Relevance These findings suggest that the added-sugar labeling is associated with reduced costs and lower rates of obesity-associated cancers. Policymakers may consider and prioritize nutrition policies for cancer prevention in the US.
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Affiliation(s)
- Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Christina F. Griecci
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Frederick F. Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Heesun Eom
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - David D. Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - John B. Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, Massachusetts
| | - Y. Claire Wang
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York
- New York Academy of Medicine, New York
- Now with Division of Substance Abuse & Mental Health, Department of Health and Social Services, State of Delaware, Newcastle
| | - Dominique S. Michaud
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
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Hricak H, Abdel-Wahab M, Atun R, Lette MM, Paez D, Brink JA, Donoso-Bach L, Frija G, Hierath M, Holmberg O, Khong PL, Lewis JS, McGinty G, Oyen WJG, Shulman LN, Ward ZJ, Scott AM. Medical imaging and nuclear medicine: a Lancet Oncology Commission. Lancet Oncol 2021; 22:e136-e172. [PMID: 33676609 PMCID: PMC8444235 DOI: 10.1016/s1470-2045(20)30751-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022]
Abstract
The diagnosis and treatment of patients with cancer requires access to imaging to ensure accurate management decisions and optimal outcomes. Our global assessment of imaging and nuclear medicine resources identified substantial shortages in equipment and workforce, particularly in low-income and middle-income countries (LMICs). A microsimulation model of 11 cancers showed that the scale-up of imaging would avert 3·2% (2·46 million) of all 76·0 million deaths caused by the modelled cancers worldwide between 2020 and 2030, saving 54·92 million life-years. A comprehensive scale-up of imaging, treatment, and care quality would avert 9·55 million (12·5%) of all cancer deaths caused by the modelled cancers worldwide, saving 232·30 million life-years. Scale-up of imaging would cost US$6·84 billion in 2020-30 but yield lifetime productivity gains of $1·23 trillion worldwide, a net return of $179·19 per $1 invested. Combining the scale-up of imaging, treatment, and quality of care would provide a net benefit of $2·66 trillion and a net return of $12·43 per $1 invested. With the use of a conservative approach regarding human capital, the scale-up of imaging alone would provide a net benefit of $209·46 billion and net return of $31·61 per $1 invested. With comprehensive scale-up, the worldwide net benefit using the human capital approach is $340·42 billion and the return per dollar invested is $2·46. These improved health and economic outcomes hold true across all geographical regions. We propose actions and investments that would enhance access to imaging equipment, workforce capacity, digital technology, radiopharmaceuticals, and research and training programmes in LMICs, to produce massive health and economic benefits and reduce the burden of cancer globally.
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Affiliation(s)
- Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
| | - May Abdel-Wahab
- International Atomic Energy Agency, Division of Human Health, Vienna, Austria; Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt; Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Diana Paez
- International Atomic Energy Agency, Division of Human Health, Vienna, Austria
| | - James A Brink
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Lluís Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | - Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jason S Lewis
- Department of Radiology and Molecular Pharmacology Programme, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Departments of Pharmacology and Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Geraldine McGinty
- Departments of Radiology and Population Science, Weill Cornell Medical College, New York, NY, USA; American College of Radiology, Reston, VA, USA
| | - Wim J G Oyen
- Department of Biomedical Sciences and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Humanitas University, Milan, Italy; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, Netherlands; Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lawrence N Shulman
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary J Ward
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Andrew M Scott
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia; Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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Corrêa Ferreira da Silva R, Bahia LR, Machado da Rosa MQ, Malhão TA, Mendonça EDP, Rosa RDS, Araújo DV, Maya Moreira LG, Schilithz AOC, Diogenes Melo MEL. Costs of cancer attributable to excess body weight in the Brazilian public health system in 2018. PLoS One 2021; 16:e0247983. [PMID: 33705455 PMCID: PMC7951921 DOI: 10.1371/journal.pone.0247983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 02/17/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The prevalence of excess body weight (EBW) has increased over the last decades in Brazil, where 55.4% of the adult population was overweight in 2019. EBW is a well-known risk factor for several types of cancer. We estimated the federal cost of EBW-related cancers in adults, considering the medical expenditures in the Brazilian Public Health System. METHODS We calculated the costs related to 11 types of cancer considering the procedures performed in 2018 by all organizations that provide cancer care in the public health system. We obtained data from the Hospital and Ambulatory Information Systems of the Brazilian Public Health System. We calculated the fractions of cancer attributable to EBW using the relative risks from the literature and prevalence from a nationally representative survey. We converted the monetary values in Reais (R$) to international dollars (Int$), considering the purchasing power parity (PPP) of 2018. RESULTS In Brazil, the 2018 federal cost for all types of cancers combined was Int$ 1.73 billion, of which nearly Int$ 710 million was spent on EBW-related cancer care and Int$ 30 million was attributable to EBW. Outpatient and inpatient expenditures reached Int$ 20.41 million (of which 80% was for chemotherapy) and Int$ 10.06 million (of which 82% was for surgery), respectively. Approximately 80% of EBW-attributable costs were due to breast, endometrial and colorectal cancers. CONCLUSION A total of 1.76% of all federal cancer-related costs could be associated with EBW, representing a substantial economic burden for the public health system. We highlight the need for integrated policies for excess body weight control and cancer prevention.
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Affiliation(s)
| | - Luciana Ribeiro Bahia
- Institute for Health Technology Assessment, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Thainá Alves Malhão
- Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | | | - Roger dos Santos Rosa
- Social Medicine Department, Institute for Health Technology Assessment, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Denizar Vianna Araújo
- Internal Medicine Department, Institute for Health Technology Assessment, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Maria Eduarda Leão Diogenes Melo
- Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
- Department of Basic and Experimental Nutrition, Nutrition Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Das M. UK charities call for emergency government funding. Lancet Oncol 2021; 22:434. [PMID: 33640041 DOI: 10.1016/s1470-2045(21)00124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Herbrand AK, Schmitt AM, Briel M, Ewald H, Goldkuhle M, Diem S, Hoogkamer A, Joerger M, Moffa G, Novak U, Hemkens LG, Kasenda B. Association of Supporting Trial Evidence and Reimbursement for Off-Label Use of Cancer Drugs. JAMA Netw Open 2021; 4:e210380. [PMID: 33651108 PMCID: PMC7926292 DOI: 10.1001/jamanetworkopen.2021.0380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE In many health systems, access to off-label drug use is controlled through reimbursement restrictions by health insurers, especially for expensive cancer drugs. OBJECTIVE To determine whether evidence from randomized clinical trials is associated with reimbursement decisions for requested off-label use of anticancer drugs in the Swiss health system. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used reimbursement requests from routinely collected health records of 5809 patients with drug treatment for cancer between January 2015 and July 2018 in 3 major cancer centers, covering cancer care of approximately 5% of the Swiss population, to identify off-label drug use. For each off-label use indication with 3 or more requests, randomized clinical trial evidence on treatment benefits was systematically identified for overall survival (OS) or progression-free survival (PFS). Data were analyzed from August 2018 to December 2020. EXPOSURES Available randomized clinical trial evidence on benefits for OS or PFS for requested off-label use indications. MAIN OUTCOMES AND MEASURES The main outcome was the association between evidence for treatment benefit (expressed as improved OS or PFS) and reimbursement in multivariable regression models. RESULTS Among 3046 patients with cancer, 695 off-label use reimbursement requests in 303 different indications were made for 598 patients (median [interquartile range] age, 64 [53-73] years; 420 [60%] men). Off-label use was intended as first-line treatment in 311 requests (45%). Reimbursement was accepted in 446 requests (64%). For 71 indications, including 431 requests for 376 patients, there were 3 or more requests. Of these, 246 requests (57%) had no supporting evidence for OS or PFS benefit. Reimbursement was granted in 162 of 246 requests without supporting evidence (66%). Of 117 requests supported by OS benefit, 79 (67%) were reimbursed, and of 68 requests supported by PFS benefit alone, 54 (79%) were reimbursed. Evidence of OS benefit from randomized clinical trials was not associated with a higher chance of reimbursement (odds ratio, 0.76, 95% CI, 0.45-1.27). CONCLUSIONS AND RELEVANCE These findings suggest that in a health care system enabling access to off-label use, it was frequently intended as a first-line treatment in cancer care. Availability of randomized clinical trial evidence showing survival benefit was not associated with reimbursement decisions for off-label anticancer drug treatment in Switzerland. A transparent process with criteria considering clinical evidence is needed for evidence-based reimbursement decisions to ensure fair access to cancer treatments.
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Affiliation(s)
- Amanda Katherina Herbrand
- Department of Medical Oncology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Internal Medicine, St Claraspital, Basel, Switzerland
| | - Andreas M. Schmitt
- Department of Medical Oncology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Hannah Ewald
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- University Medical Library, University of Basel, Basel, Switzerland
| | - Marius Goldkuhle
- Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Stefan Diem
- Department of Oncology and Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
- Department of Oncology and Hematology, Spital Grabs, Grabs, Switzerland
| | - Anouk Hoogkamer
- Department of Medical Oncology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Markus Joerger
- Department of Oncology and Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Giusi Moffa
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Urban Novak
- Department of Medical Oncology, Bern University Hospital, Bern, Switzerland
| | - Lars G. Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- Meta-Research Innovation Center Berlin (METRICS-B), Berlin Institute of Health, Berlin, Germany
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California
| | - Benjamin Kasenda
- Department of Medical Oncology, University Hospital Basel and University of Basel, Basel, Switzerland
- Research and Development, iOMEDICO, Freiburg, Germany
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Bradley CJ, Yabroff KR, Zafar SY, Shih YCT. Time to add screening for financial hardship as a quality measure? CA Cancer J Clin 2021; 71:100-106. [PMID: 33226648 PMCID: PMC9116031 DOI: 10.3322/caac.21653] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/22/2020] [Accepted: 10/15/2020] [Indexed: 12/25/2022] Open
Abstract
Cancer treatment is associated with financial hardship for many patients and families. Screening for financial hardship and referrals to appropriate resources for mitigation are not currently part of most clinical practices. In fact, discussions regarding the cost of treatment occur infrequently in clinical practice. As the cost of cancer treatment continues to rise, the need to mitigate adverse consequences of financial hardship grows more urgent. The introduction of quality measurement and reporting has been successful in establishing standards of care, reducing disparities in receipt of care, and improving other aspects of cancer care outcomes within and across providers. The authors propose the development and adoption of financial hardship screening and management as an additional quality metric for oncology practices. They suggest relevant stakeholders, conveners, and approaches for developing, testing, and implementing a screening and management tool and advocate for endorsement by organizations such as the National Quality Forum and professional societies for oncology care clinicians. The confluence of increasingly high-cost care and widening disparities in ability to pay because of underinsurance and lack of health insurance coverage makes a strong argument to take steps to mitigate the financial consequences of cancer.
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Affiliation(s)
- Cathy J. Bradley
- University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora, Colorado
| | - K. Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - S. Yousuf Zafar
- Duke Cancer Institute, Duke-Margolis Center for Health Policy, Durham, North Carolina
| | - Ya-Chen Tina Shih
- Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Affiliation(s)
- Stacie B Dusetzina
- Vanderbilt University School of Medicine, Department of Health Policy, Nashville, Tennessee
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
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Affiliation(s)
| | - Tony Hickson
- Research & Innovation, Cancer Research UK, London, UK
| | - Iain Foulkes
- Research & Innovation, Cancer Research UK, London, UK
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Perera SK, Jacob S, Wilson BE, Ferlay J, Bray F, Sullivan R, Barton M. Global demand for cancer surgery and an estimate of the optimal surgical and anaesthesia workforce between 2018 and 2040: a population-based modelling study. Lancet Oncol 2021; 22:182-189. [PMID: 33485458 DOI: 10.1016/s1470-2045(20)30675-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The growing demand for cancer surgery has placed a global strain on health systems. In-depth analyses of the global demand for cancer surgery and optimal workforce requirements are needed to plan service provision. We estimated the global demand for cancer surgery and the requirements for an optimal surgical and anaesthesia workforce, using benchmarks based on clinical guidelines. METHODS Using models of benchmark surgical use based on clinical guidelines, we estimated the proportion of cancer cases with an indication for surgery across 183 countries, stratified by income group. These proportions were multiplied by age-adjusted national estimates of new cancer cases using GLOBOCAN 2018 data and then aggregated to obtain the estimated number of surgical procedures required globally. The numbers of cancer surgical procedures in 44 high-income countries were divided by the actual number of surgeons and anaesthetists in the respective countries to calculate cancer procedures per surgeon and anaesthetist ratios. Using the median (IQR) of these ratios as benchmarks, we developed a three-tiered optimal surgical and anaesthesia workforce matrix, and the predictions were extrapolated up to 2040. FINDINGS Our model estimates that the number of cancer cases globally with an indication for surgery will increase by 5 million procedures (52%) between 2018 (9 065 000) and 2040 (13 821 000). The greatest relative increase in surgical demand will occur in 34 low-income countries, where we also observed the largest gaps in workforce requirements. To match the median benchmark for high-income countries, the surgical workforce in these countries would need to increase by almost four times and the anaesthesia workforce by nearly 5·5 times. The greatest increase in optimal workforce requirements from 2018 to 2040 will occur in low-income countries (from 28 000 surgeons to 58 000 surgeons; 107% increase), followed by lower-middle-income countries (from 166 000 surgeons to 277 000 surgeons; 67% increase). INTERPRETATION The global demand for cancer surgery and the optimal workforce are predicted to increase over the next two decades and disproportionately affect low-income countries. These estimates provide an appropriate framework for planning the provision of surgical services for cancer worldwide. FUNDING University of New South Wales Scientia Scholarship and UK Research and Innovation Global Challenges Research Fund.
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Affiliation(s)
- Sathira Kasun Perera
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - Susannah Jacob
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Brooke E Wilson
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia; Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, World Health Organization, Geneva, Switzerland
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, World Health Organization, Geneva, Switzerland
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, Kings College, London, UK
| | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia
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Abstract
The federal spending bill enacted by the U.S. Congress in December for fiscal year 2021 totals $1.4 trillion, plus another $900 billion in emergency COVID-19 relief funding. The $1.4 trillion includes budget increases for the NIH, NCI, and FDA that help the agencies keep pace with inflation. Research advocates say more than $10 billion in emergency supplemental funds for the NIH is urgently needed to support medical research affected by the COVID-19 pandemic.
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Mayor S. Implications of the new EU-UK trade agreement for cancer care. Lancet Oncol 2021; 22:169. [PMID: 33453762 DOI: 10.1016/s1470-2045(21)00015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Khorana AA, Kuderer NM, McCrae K, Milentijevic D, Germain G, Laliberté F, MacKnight SD, Lefebvre P, Lyman GH, Streiff MB. Healthcare costs of patients with cancer stratified by Khorana score risk levels. J Med Econ 2021; 24:866-873. [PMID: 34181497 DOI: 10.1080/13696998.2021.1948681] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS Patients with cancer are at high risk of venous thromboembolism (VTE), which entails a high economic burden. The risk of cancer-associated VTE can be assessed using the Khorana score (KS), a validated VTE risk prediction algorithm. This study compared healthcare costs associated with different KS in a population of patients newly diagnosed with cancer. METHODS The Optum Clinformatics DataMart database (01/01/2012-09/30/2017) was used to select adult patients with ≥1 hospitalization or ≥2 outpatient claims with a cancer diagnosis (index date) initiated on systemic therapy or radiation therapy. Patients were classified in mutually exclusive cohorts based on KS (i.e. KS = 0, 1, 2 or ≥3). The observation period spanned from index to the earliest among the end of data availability, death, end of insurance coverage, or 12 months. RESULTS In total 6,194 patients (KS = 0: 2,488; KS = 1: 2,125; KS = 2: 1,074; KS ≥ 3: 507) were included. On average, patients were aged 68 years, 48-52% were female, and the Quan-Charlson comorbidity index ranged between 1.1 and 1.4. Over the observation period, all-cause total healthcare costs per patient per month (PPPM) were $8,826 (KS = 0), $11,598 (KS = 1), $14,028 (KS = 2), and $16,211 (KS ≥ 3). Using the KS = 0 cohort as a reference, adjusted PPPM costs were $2,506, $4,775, and $6,452 higher in the KS = 1, KS = 2, and KS ≥ 3 cohorts, respectively. Hospitalization and outpatient costs were the main drivers of these differences. Similar results were found for VTE-related costs, which represented 4-11% of the total all-cause cost difference between KS cohorts. LIMITATIONS Residual confounders; results may not be generalized to patients with other insurance plans or those who received treatments other than systemic therapy or radiation therapy. CONCLUSIONS This real-world analysis found that cancer patients at higher risk of VTE (based on KS) incurred significantly greater all-cause and VTE-related healthcare costs compared with cancer patients at lower risk of VTE.
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Affiliation(s)
- Alok A Khorana
- Cleveland Clinic and Case Comprehensive Cancer Center, Cleveland, OH, USA
| | | | - Keith McCrae
- Cleveland Clinic and Case Comprehensive Cancer Center, Cleveland, OH, USA
| | | | | | | | | | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, and University of Washington, Seattle, WA, USA
| | - Michael B Streiff
- Division of Hematology, Department of Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA
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50
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Shenoy SR, Dey B. Funding for cancer research by an Indian funding agency, DBT. J Biosci 2021; 46:2. [PMID: 33576340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cancer is a group of diseases with major societal impact and accounts for approximately 55 percent of mortality in India. The Indian population is increasing in size and gradually ageing. As a result, the number of people diagnosed with and dying of cancer are increasing. Government funding agencies such as the Department of Biotechnology (DBT) has a clear definitive role in the management and control of cancer. Through Research and Development programs and multi-institutional networking programs, DBT has provided resources to individual investigators and to institutions, to carry out basic, applied, translational and clinical research and to develop new methods to prevent and treat disease and to conduct research especially in challenging areas pertaining to different types of cancer. This article summarizes the funding provided by DBT for different cancer research programs.
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Affiliation(s)
- Sandhya R Shenoy
- Medical Biotechnology Group, Department of Biotechnology, Ministry of Science and Technology, Lodi Road, New Delhi 110 003, India
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