Sujet(s)
Analyse coût-bénéfice , Coûts des soins de santé , Tumeurs du rectum/économie , Tumeurs du rectum/thérapie , Observation (surveillance clinique)/économie , Chimioradiothérapie , Humains , Amérique latine , Proctectomie/économie , Qualité de vie , Tumeurs du rectum/diagnostic , Résultat thérapeutiqueSujet(s)
Humains , Tumeurs du rectum/économie , Tumeurs du rectum/thérapie , Coûts des soins de santé , Analyse coût-bénéfice , Observation (surveillance clinique)/économie , Qualité de vie , Tumeurs du rectum/diagnostic , Résultat thérapeutique , Chimioradiothérapie , Proctectomie/économie , Amérique latineRÉSUMÉ
AIM: Managed Flow C20 (MFC20) is an integrated care pathway (ICP) for rectal cancer implemented at a public teaching hospital. This study aims to quantify resource utilization and estimate direct costs and outcomes associated with the use of this ICP. METHODS: We evaluated consecutive rectal cancer patients treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery, comparing the period before the ICP implementation (Pre-MFC20 group) and after (MFC20 group). We assessed times between treatment steps and quantified the resources utilized, as well as their costs. RESULTS: There were 112 patients in the Pre-MFC20 group and 218 in the MFC20 group. The mean treatment intervals were significantly shorter in the MFC20 group - from the first medical consultation to nCRT (48.3 vs. 87.5 days; Pâ<â0.001); and from nCRT to surgery (14.8 vs. 23.0 weeks; Pâ<â0.001) - as was the mean total treatment time (192.0 vs. 290.2 days; Pâ<â0.001). Oncology consultations, computed tomography, MRI, and radiotherapy sessions were utilized more frequently in the Pre-MFC20 group (Pâ<â0.001). The median per-patient cost was US$11â180.92 in the Pre-MFC20 group, compared with US$10â412.88 in the MFC20 group (Pâ=â0.125). Daily hospital charges and consultations were the major determinants of the total cost of the treatment. There was no statistical difference in overall survival in the time periods examined. CONCLUSION:: Implementation of a rectal cancer ICP reduced all treatment intervals and promoted rational utilization of oncology consultations and imaging, without increment in per-patient costs or detrimental effects in overall survival.