The Impact of National Surveillance for Liver Cancer: Results from Real-World Setting in Korea

Background/Aims@#The National Liver Cancer Surveillance Program (NLCSP) was established in 2003 to reduce the socioeconomic burden imposed by liver cancer (LC). We aimed to investigate the effectiveness of the NLCSP in South Korea with respect to survival benefits and cost, after adjusting for various confounding factors. @*Methods@#We used the National Health Insurance Service claims data linked with the NLCSP from 2004 to 2015. The Cox proportional hazard model and generalized linear model were used to determine the effects of the NLCSP on the early detection of LC, survival, and medical costs. @*Results@#From 2006 to 2010, 66,632 patients (surveillance group: 10,527 and no surveillance group: 56,105) newly diagnosed with LC were included in the study. The odds of the early detection of LC was 1.82 (95% confidence interval [CI], 1.73 to 1.93) times higher among patients who participated in the NLCSP once within the 2-year period prior to the diagnosis of LC than among those who did not participate in the surveillance program. The mortality rate of patients who participated in the NLCSP was 22.0% lower (hazard ratio, 0.78; 95% CI, 0.76 to 0.80) than that of those who did not participate. When compared with the group who did not participate in surveillance, the group who participated in the NLCSP had higher total medical costs; however, their cost per day was lower after adjustment during the follow-up period. @*Conclusions@#This study highlights the survival benefit in patients who participated in the NLCSP and the need for continuous improvements of the NLCSP in South Korea.

Physicians' preferences and perceptions regarding donor selection in allogeneic stem cell transplantation in Korea when a matched domestic donor is not available

BACKGROUND: A number of alternative donor options exist for patients who fail to find domestic HLA-matched donors for allogeneic hematopoietic stem cell transplantation (allo-HSCT). We assessed physicians' perspectives on allo-HSCT donor selection when a matched domestic donor is not available. METHODS: We administered a questionnaire survey to 55 hematologists (response rate: 28%) who attended the annual spring conference of the Korean Society of Haematology in 2015. The questionnaire contained four clinical allo-HSCT scenarios and the respondents were asked to choose the most preferred donor among the given options. RESULTS: In all four scenarios, the hematologists preferred a matched international donor over partially mismatched unrelated domestic or haplo-matched family donors. The numbers of hematologists who chose a matched international donor (HLA 8/8) in cases of acute myeloid leukemia, chronic myeloid leukemia, acute lymphoblastic leukemia, and aplastic anemia were 37 (67.3%), 41 (74.6%), 33 (60.0%), and 36 (65.5%), respectively. The important factors that affected donor selection included “expecting better clinical outcomes (40.5%)” and “lower risk of side effects (23.4%).” The majority of participants (80%) responded that allo-HSCT guidelines for donor selection customized for the Korean setting are necessary. CONCLUSION: Although hematologists still prefer perfectly matched foreign donors when a fully matched domestic allo-HSCT donor is not available, we confirmed that there was variation in their responses. For evidence-based clinical practice, it is necessary to provide further comparative clinical evidence on allo-HSCT from haplo-matched family donors and fully matched unrelated international donors.

A Cost Benefit Analysis of Individual Home Visiting Health Care

PURPOSE: The purpose of this study is to evaluate the costs and benefits of individual home visiting health care using secondary data and literature review. METHODS: The total number of subjects was 1,008,837. A specific program was classified into disease management, care of infant, child and women, or elderly care. The costs and effects of a program were identified from a societal perspective, and the effects were converted into monetary terms or benefits. The total cost was calculated in the way that medical expenses, travel costs and productivity losses were offset by the decrease in benefits and thus only the program budget was included in the total cost. RESULTS: The total program cost was 47.6 billion won per year and the total annual benefit was estimated at 435.6 billion won. The benefits of arthritis management were the biggest among disease management programs. The net benefit was 388.0 billion won per year and the benefit/cost ratio was 9.16. CONCLUSION: Home visiting health care was validated to be economically effective. It made a positive contribution to improving the health status of vulnerable populations and reducing medical expenses. These results suggest that home visiting care should be extended more broadly to vulnerable populations.

Cost-Effectiveness of Genexol-PM for Treating Metastatic Breast Cancer / 한국유방암학회지

PURPOSE: The aim of this study was to determine the incremental effectiveness (the differences in progression-free survival between treatments), the incremental cost and the incremental cost-effectiveness of Genexol-PM compared to Paclitaxel when these drugs were used as treatment for patients with metastatic breast cancer. METHODS: In the absence of any comparative direct evidence of the relative efficacy of Paclitaxel and Genexol-PM in this setting, a meta-analysis was conducted to determine the effects of the Paclitaxel on the health outcome. The decision tree model was constructed to evaluate the two treatment regimens. All the costs are in 2008 Korean Won (KW) and they were evaluated according to the 3rd party payer perspective, and the direct nonmedical and indirect costs were excluded. RESULTS: When compared with Paclitaxel, Genexol-PM was shown to increase the response rate and the time to progression for patients with metastatic breast cancer. Although the overall treatment costs of Genexol-PM were slightly higher than those of Paclitaxel, Genexol-PM was associated with a delayed time to progression of 4.78 months per patient. The incremental cost effectiveness ratio for Genexol-PM versus Paclitaxel was KW 2,295,228 per year gained, which is far below the per capita GDP or the threshold of the willingness-to-pay in Korea. CONCLUSION: Compared with Paclitaxel, Genexol-PM for treating metastatic breast cancer is within the acceptable range of the cost-effectiveness ratio for medical intervention.

Cost-Effectiveness of Genexol-PM for Treating Metastatic Breast Cancer / 한국유방암학회지

PURPOSE: The aim of this study was to determine the incremental effectiveness (the differences in progression-free survival between treatments), the incremental cost and the incremental cost-effectiveness of Genexol-PM compared to Paclitaxel when these drugs were used as treatment for patients with metastatic breast cancer. METHODS: In the absence of any comparative direct evidence of the relative efficacy of Paclitaxel and Genexol-PM in this setting, a meta-analysis was conducted to determine the effects of the Paclitaxel on the health outcome. The decision tree model was constructed to evaluate the two treatment regimens. All the costs are in 2008 Korean Won (KW) and they were evaluated according to the 3rd party payer perspective, and the direct nonmedical and indirect costs were excluded. RESULTS: When compared with Paclitaxel, Genexol-PM was shown to increase the response rate and the time to progression for patients with metastatic breast cancer. Although the overall treatment costs of Genexol-PM were slightly higher than those of Paclitaxel, Genexol-PM was associated with a delayed time to progression of 4.78 months per patient. The incremental cost effectiveness ratio for Genexol-PM versus Paclitaxel was KW 2,295,228 per year gained, which is far below the per capita GDP or the threshold of the willingness-to-pay in Korea. CONCLUSION: Compared with Paclitaxel, Genexol-PM for treating metastatic breast cancer is within the acceptable range of the cost-effectiveness ratio for medical intervention.

Authors' Reply to "Is Hib Vaccine of Economic Value in South Korea?"

No abstract available.

Cost-Benefit Analysis of Haemophilus Influenzae Type B Immunization in Korea

An economic evaluation of Haemophilus influenzae type b (Hib) immunization was conducted to examine whether Hib immunization should be included in the Korea's national immunization program. The costs and benefits included direct and indirect values and an estimation of the economic efficiency. We determined that a universal Hib immunization program in Korea would prevent 17 deaths and 280 invasive Hib cases. When we assumed the one Hib immunization cost as 26,000 won, the national Hib immunization would cost 34.6 billion won. Costs for various Hib diseases were estimated at 26.8 billion won (11.8 billion won from direct costs and 14.9 billion won from indirect costs). A benefit-cost ratio of 0.77 showed that the economic efficiency of the integration of Hib immunization in Korea is low because of the low incidence rate of Hib disease and high price of vaccine. However, if the Hib immunization cost decrease to less than 20,000 won, a benefit-cost ratio increase to 1.0 and above, integrating Hib immunization into the national immunization program with economic efficiency can be considered.