Timeliness of access to lung cancer diagnosis and treatment: A scoping literature review.

The Institute of Medicine recently called for increased understanding of and commitment to timely care. Lung cancer can be difficult to diagnose, resulting in delays that may adversely affect survival; rapid diagnosis and treatment therefore is critical for enabling improved patient outcomes. This scoping review provides an update on timeliness of lung cancer care over the past decade. We searched PubMed for English-language articles published from 2007 to 2016 that report wait time intervals related to diagnosis and treatment of lung cancer. Two authors independently reviewed titles and abstracts for inclusion. Abstracted data included sample size, patient population, study type, dates of study, wait times, and information on disparities, survival, costs, healthcare utilization, and interventions. The final review included 65 studies from 21 different countries. A total of 96 unique variations of wait intervals were reported (e.g., time to diagnosis from first pulmonologist visit, imaging, or initial evaluation), making comparisons across studies difficult. The most common interval was diagnosis to treatment initiation, with reported medians ranging from 6 to 45 days. Fourteen articles reported information on survival, 14 on healthcare utilization, 18 on disparities, and 14 on interventions; results varied by study. Significant variation exists in how access to care time delays are reported. Many patients across different facilities and countries appear to be facing substantial waits to receive lung cancer diagnosis and care. Further research, using common wait-interval metrics, is needed to evaluate and improve timeliness of lung cancer diagnosis and treatment.

Modeling and Cost-Effectiveness in HIV Prevention.

With HIV funding plateauing and the number of people living with HIV increasing due to the rollout of life-saving antiretroviral therapy, policy makers are faced with increasingly tighter budgets to manage the ongoing HIV epidemic. Cost-effectiveness and modeling analyses can help determine which HIV interventions may be of best value. Incidence remains remarkably high in certain populations and countries, making prevention key to controlling the spread of HIV. This paper briefly reviews concepts in modeling and cost-effectiveness methodology and then examines results of recently published cost-effectiveness analyses on the following HIV prevention strategies: condoms and circumcision, behavioral- or community-based interventions, prevention of mother-to-child transmission, HIV testing, pre-exposure prophylaxis, and treatment as prevention. We find that the majority of published studies demonstrate cost-effectiveness; however, not all interventions are affordable. We urge continued research on combination strategies and methodologies that take into account willingness to pay and budgetary impact.