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7.
BMC Public Health ; 19(1): 1065, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391013

RESUMO

BACKGROUND: Cancer outcomes vary widely among different countries. However, comparisons of cost-effectiveness and cost-efficiency of different systems are complex because the incidences of different cancers vary across countries and their chances of cure also differ substantially. We aim to propose a new standardized method for global comparison and to explore its relationship with economic indicators. METHODS: Cancer statistics from all 184 countries and 27 cancers listed in GLOBOCAN 2012 were analyzed. The complement of age-standardized mortality/incidence ratio [1 - (ASM/ASI)] was taken as the proxy relative survival (RS). Accounting for various country-specific cancer patterns, the cancer site-standardized proxy RS (proxy SS-RS) of individual countries were calculated by weighting the proportion of specific cancer sites as compared with the global pattern of incidence. Economic indicators of different countries listed by the World Bank were correlated with corresponding proxy SS-RS. RESULTS: Substantial variation in site-specific survival and new case distribution supported the use of proxy SS-RS, which ranged from 0.124 to 0.622 (median 0.359). The median total health expenditure per capita (HEpc) increased from US$44 for countries with proxy SS-RS < 0.25, to US$4643 for countries with proxy SS-RS ≥0.55. Results from logarithmic regression model showed exponential increase in total HEpc for better outcome. The expenditure varied widely among different strata, with the widest difference observed among countries with SS-RS ≥0.55 (total HEpc US$1412-$9361). CONCLUSIONS: Similar to age-standardization, cancer site-standardization adjusted for variation in pattern of cancer incidence provides the best available and feasible strategies for comparing cancer survivals across countries globally. Furthermore, cancer outcome correlated significantly with economic indicators and the amount of HEpc escalated exponentially. Our findings call for more in-depth studies applying cancer-site standardization to provide essential data for sharing of experience and urgent actions by policy makers to develop comprehensive and financially sustainable cancer plan for greater equity.


Assuntos
Saúde Global/estatística & dados numéricos , Neoplasias/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Humanos , Incidência , Neoplasias/economia , Neoplasias/mortalidade , Taxa de Sobrevida
8.
Indian J Cancer ; 56(3): 282-284, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31389400

RESUMO

This article presents a brief account of the founding of the Tata Memorial Hospital. It draws upon archival material to show that this was not a mere philanthropic act but a scheme carefully thought-out by the Trustees of the Sir Dorabji Tata Trust. It discusses the major concerns of the Trustees as they deliberated upon establishing the Hospital.


Assuntos
Institutos de Câncer/história , Eficiência Organizacional , Neoplasias/prevenção & controle , Competência Profissional , Curadores/organização & administração , Institutos de Câncer/normas , História do Século XX , História do Século XXI , Humanos , Neoplasias/economia
10.
Asia Pac J Clin Oncol ; 15(6): 309-315, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31313475

RESUMO

AIM: To quantify the direct out-of-pocket patient co-payments and time opportunity costs (length of hospital stay) incurred by Indigenous and non-Indigenous persons diagnosed with cancer during the first year postdiagnosis. METHODS: CancerCostMod was used, which is a model of cancer costs based upon a whole-of-population data linkage. The base population was a census of all persons diagnosed with cancer in Queensland, Australia between 1 July 2011 and 30 June 2012 (n = 25,553). Individual records were linked to corresponding Queensland Health Admitted Patient Data Collection, Emergency Data Information System, Medicare Benefits Schedule, and Pharmaceutical Benefits Scheme records between 1 July 2011 and 30 June 2015. Queensland data were weighted to be representative of the Australian population (approximately 123,900 Australians, 1.7% Indigenous Australians). RESULTS: After adjusting for age, sex, rurality, area-based deprivation, and cancer group, Indigenous Australians accrued significantly less in postdiagnosis patient co-payments at 0-6 months (61% less) and 7-12 months (63% less). Indigenous Australians also had significantly fewer postdiagnosis hospitalizations at 0-6 months (21% fewer) and 7-12 months (27% fewer). CONCLUSION: There is growing concern regarding the financial burden of cancer to the patient. The time spent away from family and their community may also have an important time opportunity cost, which may affect a person's decision to undertake or continue treatment. This is the first study in Australia to identify the financial cost of co-payments for Indigenous people with cancer, as well as the number and length of hospitalizations as drivers of time opportunity costs.


Assuntos
Efeitos Psicossociais da Doença , Gastos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Neoplasias/economia , Austrália , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Armazenamento e Recuperação da Informação , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Queensland/epidemiologia
11.
Scand J Public Health ; 47(5): 482-491, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31313982

RESUMO

Aims: Productivity losses related to premature cancer mortality have been assessed for most developed countries but results for Russia are limited to cross-sectional reports. The aim of this study was to quantify productivity costs due to cancer mortality in Russia between 2001 and 2015 and project this to 2030. Methods: Cancer mortality data (2001-2015) were acquired from the State Cancer Registry, whereas population data, labour force participation rates and annual earnings were retrieved from the Federal State Statistics Service. Cancer mortality was projected to 2030 and the human capital approach was applied to estimate productivity losses. Results: The total annual losses increased from US6.5b in 2001-2005 to US$8.1b in 2011-2015, corresponding to 0.24% of the annual gross domestic product. The value is expected to remain high in 2030 (US$7.5b, 0.14% of gross domestic product). Productivity losses per cancer death are predicted to grow faster in women (from US$18,622 to US$22,386) than in men (from US$25,064 to US$28,459). Total losses were found to be highest for breast cancer in women (US$0.6b, 20% of overall losses in women) and lung cancer in men (US$1.2b, 24%). The absolute predicted change of annual losses between 2011-2015 and 2026-2030 was greatest for cervix uteri (+US$214m) in women and for lip, oral and pharyngeal cancers in men (+US$182m). Conclusions: In Russia, productivity losses due to premature cancer mortality are substantial. Given the expected importance especially for potentially preventable cancers, steps to implement effective evidence-based national cancer control policies are urgently required.


Assuntos
Efeitos Psicossociais da Doença , Eficiência , Mortalidade Prematura , Neoplasias/economia , Neoplasias/mortalidade , Feminino , Humanos , Expectativa de Vida , Masculino , Federação Russa/epidemiologia
12.
Value Health ; 22(7): 762-767, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31277821

RESUMO

OBJECTIVES: To evaluate the relationship between cancer history and cost-related medication nonadherence (CRN) as well as cost-coping strategies, by health insurance coverage. METHODS: We used the 2013 to 2016 National Health Interview Survey to identify adults aged 18 to 64 years with (n = 3599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included (1) CRN, measured as skipping, taking less, or delaying medication because of cost, and (2) cost-coping strategies, measured as requesting lower cost medication or using alternative therapies to save money. Separate multivariable logistic regressions were used to calculate the adjusted odds ratios (AORs) of CRN and cost-coping strategies associated with cancer history, stratified by insurance. RESULTS: Cancer survivors were more likely than adults without a cancer history to report CRN (AOR 1.26; 95% confidence interval [CI] 1.10-1.43) and cost-coping strategies (AOR 1.10; 95% CI 0.99-1.19). Among the privately insured, the difference in CRN by cancer history was the greatest among those enrolled in high-deductible health plans (HDHPs) without health savings accounts (HSAs) (AOR 1.78; 95% CI 1.30-2.44). Among adults with HDHP and HSA, cancer survivors were less likely to report cost-coping strategies (AOR 0.62; 95% CI 0.42-0.90). Regardless of cancer history, CRN and cost-coping strategies were the highest for those uninsured, enrolled in HDHP without HSA, and without prescription drug coverage under their health plan (all P<.001). CONCLUSIONS: Cancer survivors are prone to CRN and more likely to use cost-coping strategies. Expanding options for health insurance coverage, use of HSAs for those with HDHP, and enhanced prescription drug coverage may effectively address CRN.


Assuntos
Antineoplásicos/economia , Antineoplásicos/uso terapêutico , Sobreviventes de Câncer/psicologia , Gastos em Saúde , Cobertura do Seguro/economia , Seguro Saúde/economia , Adesão à Medicação , Neoplasias/tratamento farmacológico , Neoplasias/economia , Adolescente , Adulto , Redução de Custos , Dedutíveis e Cosseguros/economia , Substituição de Medicamentos/economia , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Feminino , Pesquisas sobre Serviços de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Poupança para Cobertura de Despesas Médicas , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/psicologia , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
13.
Jpn J Clin Oncol ; 49(8): 708-713, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31329917

RESUMO

BACKGROUND: Medical tourism has grown globally, especially in oncology field, but it may cause serious problems. We aimed to elucidate concerns generated by medical tourism at a Japanese hospital and recommend solutions. METHODS: We evaluated 72 consecutive patients with cancer who had traveled from abroad to receive second opinions, clinical examinations or treatments at our hospital between January 2015 and December 2016. Data were retrospectively collected to include the purpose of patients' visits, presence and content of referral documents, details of treatments provided at our hospital, concordance between treatments received and patients' expectations, troublesome hospital incidents, risks of travel and problems with payment. RESULTS: The purpose of the visit was actual cancer treatment in the majority of the cases. Thirteen patients could speak neither Japanese nor English. Inadequate content in patient referral documents and discordance between information from the referring physician and findings at first examination were the main issues observed in the pre-treatment phase; 33 patients decided to receive treatment at our hospital. Language differences caused problems in patients' understanding of instructions and explanations during treatment. Additional problems included inaccurate self-evaluation of disease status, differences in cultural habits and requests for inappropriate and/or unavailable therapies. No major issues that could lead to injury in patients or medical staff were observed. Risks involved with returning home and transfer of treatment to local physicians were the main post-treatment issues. CONCLUSION: Medical tourism raises various issues. Institutional and medical staff should be adequately prepared by developing working systems.


Assuntos
Turismo Médico , Neoplasias/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cultura , Feminino , Hábitos , Gastos em Saúde , Pessoal de Saúde , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Neoplasias/economia , Estudos Retrospectivos , Viagem , Adulto Jovem
14.
Am J Health Syst Pharm ; 76(6): 381-386, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-31361838

RESUMO

PURPOSE: A novel value-based approach to evaluate costly specialty drugs for formulary addition was developed. SUMMARY: In February 2016, Stanford Health Care launched the specialty drug subcommittee (SDSC), a subcommittee of the pharmacy and therapeutics committee, responsible for the formulary review of specialty pharmaceuticals. A process was developed for value-based review that includes not only consideration of clinical trial data and institutional acquisition costs but also internal patient outcomes and a cost-effectiveness model using internal financial data. A Markov model was developed to assess the value of trabectedin, which was approved for formulary addition in April 2016, relative to the addition of dacarbazine. The economic model and internal patient outcome analysis were presented to the prescribing oncologist and the SDSC for review. Internal data revealed that fewer patients than had been estimated received trabectedin, with outcomes significantly worse than those observed in the clinical trial leading to Food and Drug Administration approval. In the cost-effectiveness model, trabectedin had higher costs and poorer outcomes compared with dacarbazine. Based on the economic model, low utilization, and real-world outcomes, trabectedin was removed from formulary and a restrictive treatment pathway for nonformulary use, developed by the primary prescriber, was implemented. This process has since been applied to 11 more specialty drugs. CONCLUSION: Internal cost-effectiveness models in combination with real-world patient outcomes data can be effective formulary management tools. Engagement and collaboration with the requesting provider are key to developing thoughtful treatment pathways.


Assuntos
Análise Custo-Benefício , Farmacoeconomia , Formulários Farmacêuticos como Assunto , Assistência Farmacêutica/organização & administração , Comitê de Farmácia e Terapêutica/organização & administração , Centros Médicos Acadêmicos/organização & administração , Ensaios Clínicos como Assunto , Dacarbazina/economia , Dacarbazina/uso terapêutico , Aprovação de Drogas/economia , Custos de Medicamentos , Revisão de Uso de Medicamentos/métodos , Revisão de Uso de Medicamentos/organização & administração , Humanos , Comunicação Interdisciplinar , Cadeias de Markov , Modelos Econômicos , Neoplasias/tratamento farmacológico , Neoplasias/economia , Trabectedina/economia , Trabectedina/uso terapêutico , Resultado do Tratamento , Estados Unidos , United States Food and Drug Administration
15.
Artigo em Inglês | MEDLINE | ID: mdl-31167441

RESUMO

Background: Health disparities related to environmental exposure exist in different industries. Cancer is currently a leading cause of morbidity and mortality worldwide. Much remains unknown about the types of work and industries that face the greatest cancer risks. In this study, we aimed to provide the overall and specific cancer incidences among all workers from 2004 to 2015. We also aimed to show the all-cause mortality for all employees with a first-ever cancer diagnosis. Methods: All workers in Taiwan in the labor insurance database in 2004-2015 were linked to the national health insurance databases. The annual overall and specific cancer incidences in 2004-2015 were calculated and stratified by industry and gender. Age-standardized incidence rates were also calculated. Results: A total of 332,575 workers (46.5% male) who had a first-ever cancer diagnosis from 2004-2015 were identified from 16,720,631 employees who provided 1,564,593 person-years of observation. The fishing, wholesale, construction, and building industries were identified as high-risk industries, with at least 5% of employees within them receiving a first-ever cancer diagnosis. Temporal trends of cancer incidences showed a range from 235.5 to 294.4 per 100,000 with an overall upward trend and an increase of 1.3-fold from 2004 to 2015. There were significant increases over that time for breast cancer (25%); colon cancer (8%); lung, bronchial, and tracheal cancers (11%); and oral cancer (1.7%). However, the incidence rates of cervical cancer and liver and intrahepatic cholangiocarcinoma decreased by 11.2% and 8.3%, respectively. Among the 332,575 workers with a first-ever cancer diagnosis, there were 110,692 deaths and a mortality rate of 70.75 per 1000 person-years. Conclusions: The overall incidence of cancer increased over the 10-year study period, probably due to the aging of the working population. High-risk industries are concentrated in the labor-intensive blue-collar class, which is related to aging and socioeconomic status intergradation.


Assuntos
Disparidades em Assistência à Saúde/economia , Neoplasias/epidemiologia , Adulto , Bases de Dados Factuais , Exposição Ambiental , Feminino , Humanos , Incidência , Indústrias , Masculino , Pessoa de Meia-Idade , Morbidade , Programas Nacionais de Saúde , Neoplasias/economia , Sistema de Registros , Classe Social , Taiwan/epidemiologia
16.
MMWR Morb Mortal Wkly Rep ; 68(22): 494-499, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31170127

RESUMO

In the United States in 2019, an estimated 16.9 million persons are living after receiving a cancer diagnosis (1). These cancer survivors face many challenges, including functional limitations, serious psychological distress (2), and other lasting and late effects of cancer treatments. Because of the high cost of cancer therapy, many cancer survivors are more likely to face substantial out-of-pocket health care expenditures and financial hardship, compared with persons without a history of cancer (3,4). Out-of-pocket expenditures and financial hardship associated with cancer have been higher among survivors aged 18-64 years than they have been among older survivors (5). To estimate annual out-of-pocket expenditures and financial hardship among cancer survivors aged 18-64 years, compared with persons without a cancer history, CDC, the American Cancer Society, and the National Cancer Institute analyzed data from the 2011-2016 Medical Expenditure Panel Survey (MEPS).* The average annual out-of-pocket spending per person was significantly higher among cancer survivors ($1,000; 95% confidence interval [CI] = $886-$1,113) than among persons without a cancer history ($622; CI = $606-$639). Financial hardship was common; 25.3% of cancer survivors reported material hardship (e.g., problems paying medical bills), and 34.3% reported psychological hardship (e.g., worry about medical bills). These findings add to accumulating evidence documenting the financial difficulties of many cancer survivors. Mitigating the negative impact of cancer in the United States will require implementation of strategies aimed at alleviating the disproportionate financial hardship experienced by many survivors. These strategies include systematic screening for financial hardship at cancer diagnosis and throughout cancer care, integration of discussions about the potential for adverse financial consequences of treatments in shared treatment decision-making, and linkage of patients and survivors to available resources to ensure access to high-quality evidence-based care.


Assuntos
Sobreviventes de Câncer , Efeitos Psicossociais da Doença , Gastos em Saúde/estatística & dados numéricos , Neoplasias/economia , Adolescente , Adulto , Sobreviventes de Câncer/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Estados Unidos , Adulto Jovem
17.
J Manag Care Spec Pharm ; 25(7): 765-769, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31232209

RESUMO

BACKGROUND: Patients with cancer often face financial toxicity. They may face financial distress because of high out-of-pocket costs that in turn can result in delays in treatment, treatment abandonment, and higher overall costs of care, all of which can have have a negative effect on patient care. A specialty pharmacy practice model can play a role in decreasing financial toxicity. OBJECTIVE: To evaluate the patient out-of-pocket costs after enrollment in manufacturer patient assistance programs, copay cards, and foundation grants by an oncology specialty pharmacy at University of Chicago Medicine (UCM). METHODS: For this quality improvement project, a retrospective analysis of prescription claims from January 2017 to June 2017 was performed. The primary outcomes included the number of patients enrolled in manufacturer patient assistance programs, copay cards, and foundation grants, along with the total dollars applied to pharmacy claims. The secondary outcome was the average days to approval of a foundation grant. Inclusion criteria for this quality improvement project included prescriptions filled at UCM Specialty Pharmacy in the 6-month time frame for an oncology indication. Exclusion criteria were prescriptions that were not filled at UCM Specialty Pharmacy due to out-of-network insurance and prescriptions that were part of a patient assistance program where the medication was directly shipped from the manufacturer. RESULTS: In the 6-month time frame, 75 patients received financial assistance, with a total cost savings of $314,857. Financial assistance was most frequently applied to the following medications: peg-filgrastim, dasatinib, abiraterone, filgrastim and filgrastim-sndz, palbociclib, venetoclax, and ruxolitinib. The cost savings of these interventions ranged between $5 and $13,138 per prescription claim. The average days from date of insurance approval to date of financial grant approval was 1.2 days. CONCLUSIONS: This project demonstrates the importance of an oncology specialty pharmacy team in ensuring timely approval of a foundation grant and reducing financial toxicity, which can play a major role in access to therapy. DISCLOSURES: No outside funding supported this project. The authors have no conflicts of interest to report. This project was presented at the Vizient University Health System Consortium Pharmacy Network Resident Poster Session; December 1, 2017; Orlando, FL.


Assuntos
Antineoplásicos/economia , Gastos em Saúde/estatística & dados numéricos , Neoplasias/tratamento farmacológico , Serviço de Farmácia Hospitalar/economia , Centros Médicos Acadêmicos , Redução de Custos , Custos de Medicamentos , Indústria Farmacêutica/economia , Acesso aos Serviços de Saúde/economia , Humanos , Oncologia , Neoplasias/economia , Serviço de Farmácia Hospitalar/organização & administração , Melhoria de Qualidade , Estudos Retrospectivos , Fatores de Tempo
18.
BMC Health Serv Res ; 19(1): 392, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208422

RESUMO

BACKGROUND: The Patient Protection and Affordable Care Act (ACA) eliminated the cost-sharing requirement for several preventive cancer screenings. This study examined the cancer screening utilization of mammogram, Pap smear and colonoscopy in Medicare fee-for-service (FFS) under the ACA. METHODS: The primary data were the 2007-2013 Medicare Current Beneficiary Survey linked to FFS claims. The effect of the cost-sharing removal on the probability of receiving a preventive cancer screening test was estimated using a logistic regression, separately for each screening test, adjusting for the complex survey design. The model was also separately estimated for different socioeconomic and race/ethnic groups. The study sample included beneficiaries with Part B coverage for the entire calendar year, excluding beneficiaries in Medicaid or Medicare Advantage plans. Beneficiaries with a claims-documented or self-reported history of targeted cancers, who were likely to have diagnostic tests or have surveillance screenings were excluded. The screening measures were constructed separately following Medicare coverage and U.S. Preventive Services Task Force (USPSTF) recommendations. We measured the screening utilization outcome drawing from claims data, as well as using the self-reported survey data. RESULTS: After the cost-sharing removal policy, we found no statistically significant difference in a beneficiary's probability of receiving a colonoscopy (transition period: OR = 1.08, 95% CI = 0.90-1.29; post-policy period: OR = 1.08, 95% CI = 0.83-1.42), a mammogram (transition period: OR = 1.03, 95% CI = 0.91-1.17; post-policy period: OR = 1.07, 95% CI = 0.88-1.30), or a biennial Pap smear (transition period: OR = 0.87, 95% CI = 0.69-1.09; post-policy period: OR = 0.72, 95% CI = 0.51-1.03) in claims-based measures following Medicare coverage. Similarly, we found null effects of the policy change on utilization of colonoscopy among enrollees 50-75 years old, biennial mammograms by women 50-74, and triennial Pap smear tests among women 21-65 in claims-based measures according to USPSTF. The findings from survey-based measures were consistent with the estimates from claims-based measures, except that the use of Pap smear declined since 2011. Further, the policy change did not increase utilization in patients with disadvantaged socioeconomic characteristics. Yet the disparate patterns in adjusted screening rates by socioeconomic status and race/ethnicity persisted over time. CONCLUSIONS: Removing out-of-pocket costs for screenings did not provide enough incentives to increase the screening rates among Medicare beneficiaries.


Assuntos
Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/estatística & dados numéricos , Medicare/economia , Neoplasias/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços Preventivos de Saúde , Idoso , Custo Compartilhado de Seguro , Análise Custo-Benefício , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Cobertura do Seguro , Masculino , Pessoa de Meia-Idade , Neoplasias/economia , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/estatística & dados numéricos , Estados Unidos
19.
BMC Cancer ; 19(1): 426, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064346

RESUMO

BACKGROUND: Public health efforts to prevent human papillomavirus (HPV)-related cancers include HPV vaccination and cervical cancer screening. We quantified the annual healthcare cost of six HPV-related cancers in order to provide inputs in cost-effectiveness analyses and quantify the potential economic savings from prevention of HPV-related cancers in Norway. METHODS: Using individual patient-level data from three unlinked population-based registries, we estimated the mean healthcare costs 1) annually across all phases of disease, 2) during the first 3 years of care following diagnosis, and 3) for the last 12 months of life for patients diagnosed with an HPV-related cancer. We included episodes of care related to primary care physicians, specialist care (private specialists and hospital-based care and prescriptions), and prescription drugs redeemed at pharmacies outside hospitals between 2012 and 2014. We valued costs (2014 €1.00 = NOK 8.357) based on diagnosis-related groups (DRG), patient copayments, reimbursement fees and pharmacy retail prices. RESULTS: In 2014, the total healthcare cost of HPV-related cancers amounted to €39.8 million, of which specialist care accounted for more than 99% of the total cost. The annual maximum economic burden potentially averted due to HPV vaccination will be lower for vulvar, penile and vaginal cancer (i.e., €984,620, €762,964 and €374,857, respectively) than for cervical, anal and oropharyngeal cancers (i.e., €17.2 million, €6.7 million and €4.6 million, respectively). Over the first three years of treatment following cancer diagnosis, patients diagnosed with oropharyngeal cancer incurred the highest total cost per patient (i.e. €49,774), while penile cancer had the lowest total cost per patient (i.e. €18,350). In general, costs were highest the first year following diagnosis and then declined; however, costs increased rapidly again towards end of life for patients who did not survive. CONCLUSION: HPV-related cancers constitute a considerable economic burden to the Norwegian healthcare system. As the proportion of HPV-vaccinated individuals increase and secondary prevention approaches advance, this study highlights the potential economic burden avoided by preventing these cancers.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Neoplasias/economia , Infecções por Papillomavirus/economia , Vacinas contra Papillomavirus/economia , Adolescente , Adulto , Criança , Análise Custo-Benefício/estatística & dados numéricos , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Masculino , Neoplasias/diagnóstico , Neoplasias/terapia , Neoplasias/virologia , Noruega , Papillomaviridae/imunologia , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/terapia , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/administração & dosagem , Vacinação/economia , Adulto Jovem
20.
J Manag Care Spec Pharm ; 25(5): 555-565, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039063

RESUMO

BACKGROUND: Psychotropic polypharmacy is not uncommon among cancer patients and may contribute to the increased direct health care cost burden in this population. OBJECTIVE: To estimate average direct health care costs in the year following cancer diagnosis among cancer patients receiving psychotropic polypharmacy compared with those without psychotropic polypharmacy, using a multivariable analysis framework. METHODS: A retrospective cross-sectional study was conducted among patients aged 18 years and older diagnosed with the most commonly occurring cancers (breast, prostate, lung, and colorectal) in the United States during 2011-2012 using the deidentified Optum Clinformatics Data Mart commercial claims database. Psychotropic polypharmacy was defined as concurrent use of 2 or more psychotropic medications for at least 90 days. Direct health care costs in the year following cancer diagnosis were estimated as total medical payments made by the health plans and were derived from claims files. A generalized linear regression model with log-link function and gamma distribution was used to model average direct health care costs, controlling for baseline patient demographic and clinical covariates. RESULTS: Average annual direct health care costs for cancer patients with psychotropic polypharmacy ($53,497; SD $72,590) were higher than those without psychotropic polypharmacy ($38,255; SD $59,844), with an unadjusted average cost difference of $15,242 (P < 0.0001). In the adjusted regression model, the average difference in costs shrunk to $5,888 but remained notable. When examined by type of cancer, average direct health care costs for all cancer patients with psychotropic polypharmacy were significantly higher than those for patients without psychotropic polypharmacy, except for colorectal cancer patients. CONCLUSIONS: Overall health care costs were higher among cancer patients with psychotropic polypharmacy compared with those without psychotropic polypharmacy. Our findings support the need for future research to better understand the benefits and risks of psychotropic polypharmacy, given its potential to cause adverse health outcomes and avoidable health care utilization and costs for this vulnerable patient population. DISCLOSURES: This study was funded by the American Association of Colleges of Pharmacy (AACP) New Investigator Award mechanism, which was received by Vyas. Aroke was partially supported by the AACP grant for conducting data analysis of the study. Kogut is partially supported by Institutional Development Award Number U54GM115677 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance-CTR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health and the AACP. The authors report no conflicts of interest. An abstract of this study was presented as a poster at the American Association of Colleges of Pharmacy Annual Meeting on July 22, 2018, in Boston, MA.


Assuntos
Transtornos de Adaptação/tratamento farmacológico , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Neoplasias/economia , Psicotrópicos/economia , Transtornos de Adaptação/economia , Transtornos de Adaptação/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Neoplasias/terapia , Polimedicação , Psicotrópicos/uso terapêutico , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
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