Relationship between using cancer resource center services and patient outcomes.

PURPOSE: Psychological and social support are crucial in treating cancer. Cancer resource centers provide patients with cancer and their families with services that can help them through cancer treatment, ensure that patients receive adequate treatment, and reduce cancer-related stress. These centers offer various services, including medical guidance, health education, emotional assistance (e.g., consultations for cancer care), and access to resources such as financial aid and post recovery programs. In this study, we comprehensively analyzed how cancer resource centers assist patients with cancer and improve their clinical outcomes. METHODS: The study participants comprised patients initially diagnosed with head and neck cancer or esophageal cancer. A total of 2442 patients from a medical center in Taiwan were included in the study. Data were analyzed through logistic regression and Cox proportional hazards regression. RESULTS: The results indicate that unemployment, blue-collar work, and a lower education level were associated with higher utilization of cancer resource center services. The patients who were unemployed or engaged in blue-collar work had higher risks of mortality than did their white-collar counterparts. Patient education programs can significantly improve the survival probability of patients with cancer. On the basis of our evaluation of the utilization and benefits of services provided by cancer resource centers, we offer recommendations for improving the functioning of support systems for patients with cancer and provide suggestions for relevant future research. CONCLUSIONS: We conclude that cancer resource centers provide substantial support for patients of low socioeconomic status and improve patients' survival.

Long-Term Trends and Predictors of Medical Resource Utilization and Medical Outcomes in Inguinal Hernia Repair: A Nationwide Cohort Study.

BACKGROUND: Few studies have comprehensively and systematically analyzed nationwide samples. This study purposed to explore temporal trends and predictors of medical resource utilization and medical outcomes in these patients to obtain data that can be used to improve healthcare policies and to support clinical and administrative decision-making. METHODS: This study used nationwide population data contained in the Longitudinal Health Insurance Database of Taiwan. The 14,970 inguinal hernia repair patients were enrolled in this study (age range, 18-100 years) from 1997 to 2013 in Taiwan. After temporal trends analysis of demographic characteristics, clinical characteristics, and institutional characteristics, predictors of postoperative medical resource utilization and medical outcomes were evaluated through multiple linear regression analysis and Cox regression analysis. RESULTS: The prevalence of inguinal hernia repair per 100,000 population significantly decreased from 195.38 in 1997 to 39.66 in 2013 (p < 0.05). Demographic characteristics, clinical characteristics, and institutional characteristics were significantly associated with postoperative medical resource utilization and medical outcomes (p < 0.05). Of these characteristics, both surgeon volume and hospital volume had the strongest association. CONCLUSIONS: The inguinal hernia repair prevalence rate gradually decreased during the study period. Demographic characteristics, clinical characteristics, and institutional characteristics had strong associations with postoperative medical resource utilization and medical outcomes. Furthermore, hospital volume and surgeon volume had the strongest associations with postoperative medical resource utilization and medical outcomes. Additionally, providing the education needed to make the most advantageous medical decisions would be a great service not only to patients and their families, but also to the general population.

Effect of referral systems on costs and outcomes after hip fracture surgery in Taiwan.

OBJECTIVE: To explore the economic burdens of hip fracture surgery in patients referred to lower-level medical institutions and to evaluate how referral systems affect costs and outcomes of hip fracture surgery. DESIGN: A nationwide population-based retrospective cohort study. SETTING: All hospitals in Taiwan. PARTICIPANTS: A total of 7500 patients who had received hip fracture surgery (International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic codes 820.0 ∼ 820.9 and procedure codes 79.15, 79.35, 81.52, 81.53) performed in 1997 to 2013. MAIN OUTCOME MEASURES: Total costs including outpatient costs, inpatient costs and total medical costs and medical outcomes including 30-day readmission, 90-day readmission, infection, dislocation, revision and mortality. RESULTS: The patients were referred to a lower medical institution after hip fracture surgery (downward referral group) and 3034 patients continued treatment at the same medical institution (non-referral group). Demographic characteristics, clinical characteristics and institutional characteristics were significantly associated with postoperative costs and outcomes (P < 0.05). On average, the annual healthcare cost was New Taiwan Dollars (NT$)2262 per patient lower in the downward referral group compared with the non-referral group. The annual economic burdens of the downward referral group approximated NT$241 million (2019 exchange rate, NT$30.5 = US$1). CONCLUSIONS: Postoperative costs and outcomes of hip fracture surgery are related not only to demographic and clinical characteristics, but also to institutional characteristics. The advantages of downward referral after hip fracture surgery can save huge medical costs and provide a useful reference for healthcare authorities when drafting policies for the referral system.

Artificial Neural Network and Cox Regression Models for Predicting Mortality after Hip Fracture Surgery: A Population-Based Comparison.

This study purposed to validate the accuracy of an artificial neural network (ANN) model for predicting the mortality after hip fracture surgery during the study period, and to compare performance indices between the ANN model and a Cox regression model. A total of 10,534 hip fracture surgery patients during 1996-2010 were recruited in the study. Three datasets were used: a training dataset (n = 7,374) was used for model development, a testing dataset (n = 1,580) was used for internal validation, and a validation dataset (1580) was used for external validation. Global sensitivity analysis also was performed to evaluate the relative importances of input predictors in the ANN model. Mortality after hip fracture surgery was significantly associated with referral system, age, gender, urbanization of residence area, socioeconomic status, Charlson comorbidity index (CCI) score, intracapsular fracture, hospital volume, and surgeon volume (p < 0.05). For predicting mortality after hip fracture surgery, the ANN model had higher prediction accuracy and overall performance indices compared to the Cox model. Global sensitivity analysis of the ANN model showed that the referral to lower-level medical institutions was the most important variable affecting mortality, followed by surgeon volume, hospital volume, and CCI score. Compared with the Cox regression model, the ANN model was more accurate in predicting postoperative mortality after a hip fracture. The forecasting predictors associated with postoperative mortality identified in this study can also bae used to educate candidates for hip fracture surgery with respect to the course of recovery and health outcomes.

Rehabilitative post-acute care for stroke patients delivered by per-diem payment system in different hospitalization paths: A Taiwan pilot study.

OBJECTIVE: To explore how post-acute care (PAC) for stroke patients delivered by per-diem payment system in varying hospitalization paths affects medical care utilization and functional status. DESIGN, SETTING AND PATIENTS: A longitudinal prospective cohort study of 181 acute stroke patients in a southern Taiwan hospital and patients were separated into two groups: patients transferred from regional hospitals (group 1) and patients referred from medical centers (group 2). INTERVENTION: The intervention was a hospital based, function oriented, 3- to 12-weeks rehabilitative PAC intervention for patients with cerebrovascular diseases. MEASUREMENTS: Barthal Index, Functional Oral Intake Scale, Instrumental Activities of Daily Living Scale, EuroQoL Quality of Life Scale, and Berg Balance Scale. RESULTS: The average duration between day of stroke onset and day of admission to PAC ward was significantly (P < 0.001) shorter in group 1 (9.88 days) compared to group 2 (17.11 days). The average duration of PAC was also significantly (P < 0.01) shorter in group 1 (25.51 days) compared to group 2 (34.11 days). Finally, the average cost of PAC under per-diem payment was significantly lower (P < 0.01) in group 1 (US$2637) compared to group 2 (US$3450). Functional status significantly (P < 0.05) improved in patients who had received rehabilitative PAC. However, functional status did not significantly differ between the two groups. CONCLUSIONS: The most effective way to reduce the costs of PAC for stroke patients is to minimize the duration of their hospital stay before transfer to rehabilitative PAC. Because it substantially reduces medical costs, rehabilitative PAC should be considered standard care for stroke patients.

The effect of an anaesthetic patient information video on perioperative anxiety: A randomised study.

BACKGROUND: Despite growing evidence that an educational anaesthesia video can effectively reduce perioperative anxiety, the ideal medium for addressing perioperative anxiety is unclear. OBJECTIVE: The purpose of this study was to investigate the effect of viewing an anaesthetic patient information video on anxiety levels in patients scheduled to undergo surgery. DESIGN: A randomised controlled trial. SETTING: Pingtung Christian Hospital (PTCH), Taiwan. PATIENTS: One hundred patients were randomised to either an experimental group (n = 50) or a control group (n = 50). INTERVENTIONS: At the preoperative clinic, the experimental group watched the an 8 minute educational anaesthetic video, whereas the control group received a standard 8-min verbal briefing on anaesthesia after preoperative assessment. MAIN OUTCOMES MEASURES: The Chinese version of the Spielberger state trait anxiety inventory, which included a state scale (STAI-S) and a trait scale (STAI-T), was performed in the preoperative clinic (T1) before anaesthetic preassessment, at the preoperative holding area just before surgery (T2) and again on the third day after surgery (T3). Scores for overall satisfaction with medical care were obtained on the third day after surgery. For two time interval comparisons, effect size was used to standardise the extent of change as measured by STAI-S. RESULTS: After the educational intervention, state anxiety was lower in the experimental group than in the control group at both T2 (42.9 ±â€Š6.5 vs. 45.0 ±â€Š12.7) and T3 (40.2 ±â€Š5.3 vs. 48.8 ±â€Š8.5). Compared with control group, the experimental group had a larger effect size at T2 and T3 (-0.65 and -0.36, respectively). Overall satisfaction was significantly higher in the experimental group than in the control group (P < 0.05). CONCLUSION: Perioperative anxiety was significantly reduced and overall patient satisfaction increased after viewing a preoperative educational anaesthesia video compared with a standard verbal briefing on anaesthesia.

Neuraxial anesthesia improves long-term survival after total joint replacement: a retrospective nationwide population-based study in Taiwan.

INTRODUCTION: This study explored the effects of general (GA) and neuraxial (NA) anesthesia on the outcomes of primary total joint replacement (TJR) in terms of postoperative mortality, length of stay (LOS), and hospital treatment costs. METHODS: From 1997 to 2010, this nationwide population-based study retrospectively evaluated 7,977 patients in Taiwan who underwent primary total hip or knee replacement. We generated two propensity-score-matched subgroups, each containing an equal number of patients who underwent TJR with either GA or NA. RESULTS: Of the 7,977 patients, 2,990 (37.5%) underwent GA and 4,987 (62.5%) underwent NA. Propensity-score matching was used to create comparable GA and NA groups adjusted for age, sex, comorbidities, surgery type, hospital volume, and surgeon volume. Survival over the first three years following surgery was similar. The proportion of patients alive up to 14 years postoperatively for those undergoing NA was 58.2% (95% confidence interval [CI] 50.4 to 66.0), and for those undergoing GA it was 57.3% (95% CI 51.4 to 63.2). Neuraxial anesthesia was associated with lower median [interquartile range; IQR] hospital treatment cost ($4,079 [3,805-4,444] vs $4,113 [3,812-4,568]; P < 0.001) and shorter median [IQR] LOS (8 [7-10] days vs 8 [6-10] days, respectively; P = 0.024). CONCLUSIONS: Our results support the use of NA for primary TJR. The improvements in hospital costs persist even when anesthesia costs are removed. The mechanism underlying the association between NA and long-term survival is unknown.

Acute pesticide poisoning outcomes: a nationwide study in Taiwan.

BACKGROUND: This study presents the findings of a nationwide study of acute pesticide poisoning (APP) outcomes, including outcome predictors such as physician and hospital volume and associated factors. METHODS: This study of data contained in the Taiwan National Health Insurance Research Database analysed 27 046 patients who had been hospitalised for APP from January 1996 to December 2007. Patient characteristics were then compared among quartiles. The primary outcome measures were length of stay (LOS) and hospital treatment cost. Effect size (ES) was compared among three equally divided periods, and multiple regression models were used to identify outcome predictors. RESULTS: The overall prevalence of APP per 100 000 patients decreased from 12.43 in 1996 to 6.87 in 2007. The LOS for APP treatment was negatively associated with physician volume during the study period. Both LOS and hospital treatment cost were lowest in the high hospital volume subgroup. Comparisons of LOS and hospital treatment cost among the three periods showed that high-volume hospitals and high-volume physicians had better ESs compared to low-volume hospitals and low-volume physicians. Age and number of co-morbidities had significant positive associations with LOS, while admission year, male gender, hospital level, hospital volume and physician volume had significant negative associations with LOS (p<0.05). Hospital treatment cost and hospital level correlated positively with admission year, number of co-morbidities and LOS but correlated negatively with hospital volume and physician volume (p<0.05). CONCLUSIONS: In APP patients, treatment by a high-volume physician can reduce LOS and treatment cost.

Preoperative transarterial chemoembolization and resection for hepatocellular carcinoma: a nationwide Taiwan database analysis of long-term outcome predictors.

BACKGROUND: To explore long-term predictors of outcome after TACE and resection in a population of patients with hepatocellular carcinoma (HCC). METHODS: A total of 648 had received TACE before liver resection (TACE group) while 10,431 patients had received liver resection without TACE (LR group). Propensity scores were calculated by entering the patient data into a logistic regression model for predicting HCC outcomes. RESULTS: Compared to the LR group, the TACE group did not significantly differ in disease-free survival (DFS) (median, 17 months in the TACE group vs. 13 months in the LR group; P = 0.410) and overall-survival (OS) (median, 56 months in the TACE group vs. 54 months in the LR group; P = 0.777). The TACE group also showed that gender, liver cirrhosis, CCI score, hospital volume, and surgeon volume were independently associated with DFS while gender, CCI score and hospital level were independently associated with DFS/OS. CONCLUSIONS: This population-based cohort study provides compelling evidence that preoperative TACE does not significantly reduce DFS or OS in patients with resectable HCC. Moreover, long-term outcomes for these procedures are significantly associated with patient characteristics and hospital characteristics. Medical professionals and health care providers should carefully evaluate candidates for preoperative TACE in patients with resectable HCC.

Cost-Utility Analysis of Tenofovir Alafenamide and Entecavir in Chronic Hepatitis B Patients: A Markov Decision Model.

From the perspective of health economics, the evaluation of drug-related cost effectiveness and clinical utility is crucial. We conducted a cost-utility analysis of two first-line drugs, tenofovir alafenamide (TAF) and entecavir (ETV), in the treatment of chronic hepatitis B (CHB) patients. We performed inverse probability of treatment weighting (IPTW) to match the independent variables between the two treatment groups. The incremental cost effectiveness ratio (ICER) of the two treatment groups was simulated using a decision tree with the Markov annual-cycle model. A total of 54 patients treated with TAF and 98 with ETV from January 2016 to December 2020 were enrolled. The total medical cost in the TAF group was NT$76,098 less than that in the ETV group, and TAF demonstrated more effectiveness than ETV by 3.19 quality-adjusted life years (QALYs). When the time horizon was set at 30 years, the ICER of the TAF group compared with the ETV group was -NT$23,878 per QALY, suggesting more cost savings for TAF. Additionally, with the application of TAF, over NT$366 million (approximately US$12 million) can be saved annually. TAF demonstrates cheaper medical costs and more favorable clinical QALYs than ETV. To balance health insurance benefits and cost effectiveness, TAF is the optimal treatment for CHB.

Cost-Effectiveness Analysis of Digital Breast Tomosynthesis and Mammography in Breast Cancer Screening: A Markov Modeling Study.

BACKGROUND: Mammography (MG) has demonstrated its effectiveness in diminishing mortality and advanced-stage breast cancer incidences in breast screening initiatives. Notably, research has accentuated the superior diagnostic efficacy and cost-effectiveness of digital breast tomosynthesis (DBT). However, the scope of evidence validating the cost-effectiveness of DBT remains limited, prompting a requisite for more comprehensive investigation. The present study aimed to rigorously evaluate the cost-effectiveness of DBT plus MG (DBT-MG) compared to MG alone within the framework of Taiwan's National Health Insurance program. METHODS: All parameters for the Markov decision tree model, encompassing event probabilities, costs, and utilities (quality-adjusted life years, QALYs), were sourced from reputable literature, expert opinions, and official records. With 10,000 iterations, a 2-year cycle length, a 30-year time horizon, and a 2% annual discount rate, the analysis determined the incremental cost-effectiveness ratio (ICER) to compare the cost-effectiveness of the two screening methods. Probabilistic and one-way sensitivity analyses were also conducted to demonstrate the robustness of findings. RESULTS: The ICER of DBT-MG compared to MG was US$5971.5764/QALYs. At a willingness-to-pay (WTP) threshold of US$33,004 (Gross Domestic Product of Taiwan in 2021) per QALY, more than 98% of the probabilistic simulations favored adopting DBT-MG versus MG. The one-way sensitivity analysis also shows that the ICER depended heavily on recall rates, biopsy rates, and positive predictive value (PPV2). CONCLUSION: DBT-MG shows enhanced diagnostic efficacy, potentially diminishing recall costs. While exhibiting a higher biopsy rate, DBT-MG aids in the detection of early-stage breast cancers, reduces recall rates, and exhibits notably superior cost-effectiveness.

Cost-Effectiveness of Low-Dose Computed Tomography Screenings for Lung Cancer in High-Risk Populations: A Markov Model.

Background: Domestic and foreign studies on lung cancer have been oriented to the medical efficacy of low-dose computed tomography (LDCT), but there is a lack of studies on the costs, value and cost-effectiveness of the treatment. There is a scarcity of conclusive evidence regarding the cost-effectiveness of LDCT within the specific context of Taiwan. This study is designed to address this gap by conducting a comprehensive analysis of the cost-effectiveness of LDCT and chest X-ray (CXR) as screening methods for lung cancer. Methods: Markov decision model simulation was used to estimate the cost-effectiveness of biennial screening with LDCT and CXR based on a health provider perspective. Inputs are based on probabilities, health status utility (quality-adjusted life years (QALYs)), costs of lung cancer screening, diagnosis, and treatment from the literatures, and expert opinion. A total of 1,000 simulations and five cycles of Markov bootstrapping simulations were performed to compare the incremental cost-utility ratio (ICUR) of these two screening strategies. Probability and one-way sensitivity analyses were also performed. Results: The ICUR of early lung cancer screening compared LDCT to CXR is $-24,757.65/QALYs, and 100% of the probability agree to adopt it under a willingness-to-pay (WTP) threshold of the Taiwan gross domestic product (GDP) per capita ($35,513). The one-way sensitivity analysis also showed that ICUR depends heavily on recall rate. Based on the prevalence rate of 39.7 lung cancer cases per 100,000 people in 2020, it could be estimated that LDCT screening for high-risk populations could save $17,154,115. Conclusion: LDCT can detect more early lung cancers, reduce mortality and is cost-saving than CXR in a long-term simulation of Taiwan's healthcare system. This study provides valuable insights for healthcare decision-makers and suggests analyzing cost-effectiveness for additional variables in future research.

Predicting quality of life after breast cancer surgery using ANN-based models: performance comparison with MR.

PURPOSE: The goal was to develop models for predicting long-term quality of life (QOL) after breast cancer surgery. METHODS: Data were obtained from 203 breast cancer patients who completed the SF-36 health survey before and 2 years after surgery. Two of the models used to predict QOL after surgery were artificial neural networks (ANNs), which included one multilayer perceptron (MLP) network and one radial basis function (RBF) network. The third model was a multiple regression (MR) model. The criteria for evaluating the accuracy of the system models were mean square error (MSE) and mean absolute percentage error (MAPE). RESULTS: Compared to the MR model, the ANN-based models generally had smaller MSE values and smaller MAPE values in the test data set. One exception was the second year MSE for the test value. Most MAPE values for the ANN models ranged from 10 to 20 %. The one exception was the 6-month physical component summary score (PCS), which ranged from 23.19 to 26.86 %. Comparison of criteria for evaluating system performance showed that the ANN-based systems outperformed the MR system in terms of prediction accuracy. In both the MLP and RBF networks, surgical procedure type was the most sensitive parameter affecting PCS, and preoperative functional status was the most sensitive parameter affecting mental component summary score. CONCLUSION: The three systems can be combined to obtain a conservative prediction, and a combined approach is a potential supplemental tool for predicting long-term QOL after surgical treatment for breast cancer. RELEVANCE: Patients should also be advised that their postoperative QOL might depend not only on the success of their operations but also on their preoperative functional status.

The volume-outcome relationship in laparoscopic cholecystectomy: a population-based study using propensity score matching.

BACKGROUND: The volume-outcome relationship has been validated previously for surgical procedures and cancer treatments. However, no studies have longitudinally compared the relationships between volume and outcome, and none have systematically compared laparoscopic cholecystectomy (LC) surgery outcomes in Taiwan. This study purposed to explore the relationship between volume and hospital treatment cost after LC. METHODS: This cohort study retrospectively analyzed 247,751 LCs performed from 1998 to 2009. Hospitals were classified as low-, medium-, and high-volume hospitals if their annual number of LCs were 1-29, 30-84, ≥85, respectively. Surgeons were classified as low-, medium-, and high-volume surgeons if their annual number of LCs were 1-10, 11-24, ≥25, respectively. Hierarchical linear regression model and propensity score were used to assess the relationship between volume and hospital treatment cost. RESULTS: The mean hospital treatment cost was US $2,504.53, and the average hospital costs for high-volume hospitals/surgeons were 33/47% lower than those for low-volume hospitals and surgeons. When analyzed by propensity score, the hospital treatment cost differed significantly between high-volume hospitals/surgeons and low/medium-volume hospitals/surgeons (2,073.70 vs. 2,350.91/2,056.73 vs. 2,553.76, P < 0.001). CONCLUSIONS: Analysis using a hierarchical linear regression model and propensity score found an association between high-volume hospitals and surgeons and hospital treatment cost in LC patients. Moreover, the significant factors associated with hospital resource utilization for this procedure include age, gender, comorbidity, hospital type, hospital volume, and surgeon volume. Additionally, analysis of the treatment strategies adopted at high-volume hospitals or by high-volume surgeons may improve overall hospital treatment cost.

Volume associations in total hip arthroplasty: a nationwide Taiwan population-based study.

This cohort study retrospectively analyzed 78,364 THAs performed from 1998 to 2009. The mean hospital charge for all THAs performed during the study period was $4,131.9 dollars. The average hospital charges for high-volume hospitals and surgeons were 6% and 7% lower, respectively, than those for low-volume hospitals and surgeons. Analysis by propensity score matching showed that hospital charges significantly differed between THA procedures performed by high- and low-volume hospitals ($3,285.8 dollars versus $4,816.2 dollars, respectively) and between THA procedures performed by high- and low-volume surgeons, ($3,438.5 dollars versus $4,404.7 dollars, respectively) (P < 0.001). The data indicate that analysis and emulation of the treatment strategies used by high-volume hospitals and by high-volume surgeons may reduce overall hospital charges.

Long-term care insurance purchase decisions of registered nurses: Deep learning versus logistic regression models.

OBJECTIVE: The purpose of this study was to use a deep learning model and a traditional statistical regression model to predict the long-term care insurance decisions of registered nurses. METHODS: We Prospectively surveyed 1,373 registered nurses with a minimum of 2 years of full-time working experience at a large medical center in Taiwan: 615 who already owned long-term care insurance (LTCI), 332 who had no intention to purchase LTCI (group 1), and 426 who intended to purchase LTCI (group 2). RESULTS: After inverse probability of treatment weighting (IPTW), no statistically significant differences were identified in the study characteristics of the two groups. All the performance indices for the deep neural network (DNN) model were significantly higher than those of the multiple logistic regression (MLR) model (P<0.001). The strongest predictor of an individual's long-term care insurance decision was their risk propensity score, followed by their caregiving responsibilities, whether they live with older adult relatives, their experiences of catastrophic illness, and their openness to experience. CONCLUSIONS: The DNN model is useful for predicting long-term care insurance decisions. Its prediction accuracy can be increased through training with temporal data collected from registered nurses. Future research can explore designs for two-level or multilevel models that explain the contextual effects of the risk factors on long-term care insurance decisions.

Quality of life and cost-effectiveness of different breast cancer surgery procedures: a Markov decision tree-based approach in the framework of Predictive, Preventive, and Personalized Medicine.

Purpose: Breast cancer is a complex disease with heterogeneous outcomes that may benefit from the implementation of Predictive, Preventive, and Personalized Medicine (PPPM/3PM) strategies. In this study, we aimed to explore the potential of PPPM approaches by investigating the 10-year trends in quality of life (QOL) and the cost-effectiveness of different types of surgeries for patients with breast cancer. Methods: This prospective cohort study recruited 144 patients undergoing breast conserving surgery (BCS), 199 undergoing modified radical mastectomy (MRM), and 44 undergoing total mastectomy with transverse rectus abdominis myocutaneous flap (TRAMF) from three medical centers in Taiwan between June 2007 and June 2010. Results: All patients exhibited a significant decrease in most QOL dimension scores from before surgery to 6 months postoperatively (p < 0.05); however, from postoperative year 1 to 2, improvement in most QOL dimension scores was significantly better in the TRAMF group than in the BCS and MRM groups (p < 0.05). At 2, 5, and 10 years after surgery, the patients' QOL remained stable. In the Markov decision tree model, the TRAMF group had higher total direct medical costs than the MRM and BCS groups (US$ 32,426, US$ 29,487, and US$ 28,561, respectively) and higher average QALYs gained (7.771, 6.773, and 7.385, respectively), with an incremental cost-utility ratio (ICUR) of US$ 2,944.39 and US$ 10,013.86 per QALY gained. Conclusions: TRAMF appeared cost effective compared with BCS and MRM, and it has been proved with considerable QOL improvements in the framework of PPPM. Future studies should continue to explore the potential of PPPM approaches in breast cancer care. By incorporating predictive models, personalized treatment plans, and preventive strategies into routine clinical practice, we can further optimize patient outcomes and reduce healthcare costs associated with breast cancer treatment. Supplementary Information: The online version contains supplementary material available at 10.1007/s13167-023-00326-4.

Clinical Outcomes and Cost-Effectiveness of Osteoporosis Screening With Dual-Energy X-ray Absorptiometry.

OBJECTIVE: This study aimed to evaluate the clinical outcomes and cost-effectiveness of dual-energy X-ray absorptiometry (DXA) for osteoporosis screening. MATERIALS AND METHODS: Eligible patients who had and had not undergone DXA screening were identified from among those aged 50 years or older at Kaohsiung Veterans General Hospital, Taiwan. Age, sex, screening year (index year), and Charlson comorbidity index of the DXA and non-DXA groups were matched using inverse probability of treatment weighting (IPTW) for propensity score analysis. For cost-effectiveness analysis, a societal perspective, 1-year cycle length, 20-year time horizon, and discount rate of 2% per year for both effectiveness and costs were adopted in the incremental cost-effectiveness (ICER) model. RESULTS: The outcome analysis included 10337 patients (female:male, 63.8%:36.2%) who were screened for osteoporosis in southern Taiwan between January 1, 2012, and December 31, 2021. The DXA group had significantly better outcomes than the non-DXA group in terms of fragility fractures (7.6% vs. 12.5%, P < 0.001) and mortality (0.6% vs. 4.3%, P < 0.001). The DXA screening strategy gained an ICER of US$ -2794 per quality-adjusted life year (QALY) relative to the non-DXA at the willingness-to-pay threshold of US$ 33004 (Taiwan's per capita gross domestic product). The ICER after stratifying by ages of 50-59, 60-69, 70-79, and ≥ 80 years were US$ -17815, US$ -26862, US$ -28981, and US$ -34816 per QALY, respectively. CONCLUSION: Using DXA to screen adults aged 50 years or older for osteoporosis resulted in a reduced incidence of fragility fractures, lower mortality rate, and reduced total costs. Screening for osteoporosis is a cost-saving strategy and its effectiveness increases with age. However, caution is needed when generalizing these cost-effectiveness results to all older populations because the study population consisted mainly of women.

Minimal Clinically Important Difference (MCID) in the Functional Status Measures in Patients with Stroke: Inverse Probability Treatment Weighting.

This study proposed to evaluate the temporal trend, define the minimal clinically important difference (MCID) for five functional status measures, and identify risk factors for reaching deterioration in the MCID. This prospective cohort study analyzed 680 patients with ischemic stroke and 151 patients with hemorrhagic stroke at six hospitals between April 2015 and October 2021. All patients completed the functional status measures before rehabilitation (baseline), and at the 12th week and 2nd year after rehabilitation. Patients in the post-acute care (PAC) group exhibited significantly larger improvements for the functional status measures compared to those in the non-PAC group (p < 0.05). Patients with hemorrhagic stroke also displayed larger improvements in the functional status measures when compared to patients with ischemic stroke. Furthermore, the improvement in MCID ranged from 0.01 to 16.18 points when comparing baseline and the 12th week after rehabilitation, but the deterioration in MCID ranged from 0.38 to 16.12 points. Simultaneously, assessing the baseline and the second year after rehabilitation, the improvement in MCID ranged from 0.01 to 18.43 points, but the deterioration in MCID ranged from 0.68 to 17.26 points. Additionally, the PAC program, age, education level, body mass index, smoking, readmission within 30 days, baseline functional status score, use of Foley catheter and nasogastric tube, as well as a history of previous stroke are significantly associated with achieving deterioration in MCID (p < 0.05). These findings suggest that if the mean change scores of the functional status measures have reached the thresholds, the change scores can be perceived by patients as clinically important.

Clinical and cost-effectiveness analysis of mFOLOFX6 with or without a targeted drug among patients with metastatic colorectal cancer: inverse probability of treatment weighting.

This study investigated the cost-effectiveness and quality of life (QoL) within 1 year of receiving mFOLOFX6 with or without a targeted drug (bevacizumab or ramucirumab) as second-line treatment among patients with metastatic colorectal cancer (mCRC) following the failure of FOLFIRI + bevacizumab as first-line treatment. This prospective cohort study included patients who received a diagnosis of mCRC between March 2015 and May 2020. QoL was evaluated before treatment and at 6 months and 1 year posttreatment. All related variables were controlled using the inverse probability of treatment weighting method. Generalized estimating equations with the difference-in-difference method was used to explore changes in QoL. The incremental cost-utility ratio (ICUR) of the two groups was simulated using the annual-cycle Markov decision tree model. Finally, 39 and 76 patients were included in the targeted and nontargeted agent groups, respectively. At 6 months after treatment, QoL of the two groups improved significantly, but the targeted agent group had significantly better QoL than did the nontargeted agent group at 1 year posttreatment (P < 0.05). When the time frame was set to 20 years, the ICUR of the targeted agent group compared with the nontargeted agent group was US$32,052 per quality-adjusted life years. Addition of a targeted drug to the second-line mFOLOFX6 regimen not only improved the patients' QoL but was also more cost effective when the willingness-to-pay threshold was set at US$33,004 (the per capita gross domestic product of Taiwan). These patients should be reimbursed for these targeted agents by the National Health Insurance scheme in Taiwan.