Hypoparathyroidism-related health care utilization and expenditure during the first postoperative year after total thyroidectomy for cancer: a comprehensive national cohort study.

Objectives: Hypoparathyroidism is the most common complication of total thyroidectomy for cancer, and requires calcium and/or vitamin D supplementation for an unpredictable period of time. The additional cost associated with this complication has not hitherto been assessed. The aim of this study was to assess the economic burden of postoperative hypoparathyroidism after total thyroidectomy for cancer in France. Methods: Based on the French national cancer cohort, which extracts data from the French National Health Data System (SNDS), all adult patients who underwent a total thyroidectomy for cancer in France between 2011 and 2015 were identified, and their healthcare resource use during the first postoperative year was compared according to whether they were treated postoperatively with calcium and/or vitamin D or not. Univariate and multivariate cost analyses were performed with the non-parametric Wilcoxon test and generalized linear model (gamma distribution and log link), respectively. Results: Among the 31,175 patients analyzed (75% female, median age: 52y), 13,247 (42%) started calcium and/or vitamin D supplementation within the first postoperative month, and 2,855 patients (9.1%) were still treated at 1 year. Over the first postoperative year, mean overall and specific health expenditures were significantly higher for treated patients than for untreated patients: €7,233 vs €6,934 per patient (p<0.0001) and €478.6 vs €332.7 per patient (p<0.0001), respectively. After adjusting for age, gender, Charlson Comorbidity index, ecological deprivation index, types of thyroid resection, lymph node dissection and complications, year and region, the incremental cost of overall health care utilization was €142 (p<0.004). Conclusion: Our study found a significant additional cost in respect of health expenditures for patients who had hypoparathyroidism after thyroidectomy for cancer, over the first postoperative year. Five-year follow-up is planned to assess the impact of more severe long-term complications on costs.

Economic Evaluations of Anticancer Drugs Based on Medico-Administrative Databases: A Systematic Literature Review.

BACKGROUND: Oncology is among the most active therapeutic fields in terms of new drug development projects, with increasingly expensive drugs. The expected clinical benefit and cost effectiveness of these treatments in clinical practice have yet to be fully confirmed. Health medico-administrative databases may be useful for assessing the value of anticancer drugs with real-world data. OBJECTIVE: The objectives of our systematic literature review (SLR) were to analyse economic evaluations of anticancer drugs based on health medico-administrative databases, to assess the quality of these evaluations, and to identify the inputs from such databases that can be used in economic evaluations of anticancer drugs. METHODS: We performed an SLR by using PubMed and Web of Science articles published from January 2008 to January 2019. The search strategy focused on anticancer drug cost-effectiveness analyses (CEAs)/cost-utility analyses (CUAs) that were entirely based on medico-administrative databases. The review reported the main choices of economic evaluation methods in the analyses. The quality of the articles was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and risk of bias assessment checklists. RESULTS: Of the 306 records identified in PubMed, 12 articles were selected, and one additional article was identified through Web of Science. Ten of the 13 articles were CEAs and three were CUAs. Most of the analyses were carried out in North America (n = 11). The economic metric used was the cost per life-year gained (n = 10) or cost per quality-adjusted life-year (n = 3). Reporting of the target analysis population and strategies in the articles was in agreement with the CHEERS guidelines. The structural assumptions underpinning the economic models displayed the poorest reporting quality among the items analysed. Representativeness bias (n = 11) and the issue of censored medical costs (n = 8) were the most frequently analysed risks. CONCLUSION: A comparison of the economic results was not relevant due to the high heterogeneity of the selected studies. Our SLR highlighted the benefits and pitfalls related to the use of medico-administrative databases in the economic evaluations of anticancer drugs.

Cancer care and public health policy evaluations in France: Usefulness of the national cancer cohort.

BACKGROUND: In the context of the national Cancer Plans of France that have changed the healthcare landscape, it has become necessary to better document and assess the related actions, and to promote research and understanding. The national cancer cohort, an exhaustive population-based cohort, was set up on the basis of the National Health Data System (SNDS) by the French National Cancer Institute. OBJECTIVES: The aim is to describe the French national cancer cohort. METHODS: All people living in France (67 million population) with universal insurance coverage and diagnosed, treated or followed up for a cancer, such as survivors, are included and will be followed up for 25 years. It contains all healthcare consumptions and reimbursements (i.e. hospitalization, outpatient care, medication…) since 2010. Every year, around 650 000 new cases are included. RESULTS: From 2010 to 2015, 6.2 million subjects have been included. Most subjects were entered in 2010, in 2015 it concerned 0.6 million. In 2015, the median age was 65 [54-76]; 51% were women. The primary cancer organ could be attributed with certitude to 87% of the people. The most frequent locations were skin (16%), breast (15%), prostate (12%), colon-rectum (11%) and lung (9%). In 2015, 40% of included subjects underwent surgery for cancer, 16% chemotherapy at hospital and 11% at least one session of radiotherapy. CONCLUSION: Based on SNDS, the cancer cohort has been designed to study cancer care use in the short-, medium- and long-term, and evaluate healthcare and public health policies.