Fractionation scheme and treatment planning method for early glottic cancer in the United States: Economic impact of different medical decisions

6518 Background: Preoperative long-course chemoradiotherapy (CRT) and short-course radiotherapy (SCR) for locally advanced rectal cancer (LARC) were found to have equivalent outcomes in three randomized trials. SCR may have lower acute toxicity and the down-staging following CRT is more well-established. At present, SCR is frequently used in Europe but has not been widely adopted in the United States (US). It is standard to deliver radiotherapy by 3D planning, while the use of Intensity-modulated radiotherapy (IMRT) is controversial. In recent years there has been an increasing focus on understanding the cost and value of cancer care. In this study we aimed to assess the economic impact of fractionation scheme and treatment planning method for payers in the US. Methods: We performed a population-based analysis of the total cost of radiotherapy for LARC in the US annually. The national annual target population of patients was calculated using the Surveillance, Epidemiology, and End Results (SEER) database. Treatment costs for various fractionation schemes were based on billing codes and 2018 pricing by Medicare's Hospital Outpatient Prospective Payment System (OPPS). The cost of chemotherapy was based on the Payment Allowance Limits for Medicare Part B Drugs by Centers for Medicare and Medicaid Services (CMS). Results: We estimate that 12,945 patients with LARC are treated with radiotherapy annually in the US. The cost of CRT with 3-D or IMRT is US$ 15,881.76 and US$ 23,744.82 per patient, respectively. With 3-D SCR the cost is US$ 5,457 per patient. The use of SCR would lead to 64-77% annual savings of US$ 125,701,387 - US$ 236,727,934 in the US compared with 3-D and IMRT based CRT, respectively. IMRT based planning increases the total cost of CRT by 49% and if adopted widely would lead to an excess cost of US$ 101,787,312 annually. Conclusions: SCR may have the potential to save in the region of US$ 0.12-0.23 billion annually in the US, likely without impacting outcomes. Lack of evidence showing benefit with costly IMRT should limit its use to clinical trials. SCR may also lead to lower personal financial toxicity. It would be reasonable for public and private payers to consider which type of radiation is most suited to reimbursement.

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Monetizing the Burden of Childhood Asthma Due to Traffic Related Air Pollution in the Contiguous United States in 2010

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157864 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7864

Author(s):

Minaal Farrukh ◽

Haneen Khreis

Keyword(s):

United States ◽

Air Pollution ◽

Economic Impact ◽

Childhood Asthma ◽

Ambient Air ◽

The United States ◽

The State ◽

Cost Calculation ◽

Cost Burden ◽

Incident Cases

Background: Traffic-related air pollution (TRAP) refers to the wide range of air pollutants emitted by traffic that are dispersed into the ambient air. Emerging evidence shows that TRAP can increase asthma incidence in children. Living with asthma can carry a huge financial burden for individuals and families due to direct and indirect medical expenses, which can include costs of hospitalization, medical visits, medication, missed school days, and loss of wages from missed workdays for caregivers. Objective: The objective of this paper is to estimate the economic impact of childhood asthma incident cases attributable to nitrogen dioxide (NO2), a common traffic-related air pollutant in urban areas, in the United States at the state level. Methods: We calculate the direct and indirect costs of childhood asthma incident cases attributable to NO2 using previously published burden of disease estimates and per person asthma cost estimates. By multiplying the per person indirect and direct costs for each state with the NO2-attributable asthma incident cases in each state, we were able to estimate the total cost of childhood asthma cases attributable to NO2 in the United States. Results: The cost calculation estimates the total direct and indirect annual cost of childhood asthma cases attributable to NO2 in the year 2010 to be $178,900,138.989 (95% CI: $101,019,728.20–$256,980,126.65). The state with the highest cost burden is California with $24,501,859.84 (95% CI: $10,020,182.62–$38,982,261.250), and the state with the lowest cost burden is Montana with $88,880.12 (95% CI: $33,491.06–$144,269.18). Conclusion: This study estimates the annual costs of childhood asthma incident cases attributable to NO2 and demonstrates the importance of conducting economic impacts studies of TRAP. It is important for policy-making institutions to focus on this problem by advocating and supporting more studies on TRAP’s impact on the national economy and health, including these economic impact estimates in the decision-making process, and devising mitigation strategies to reduce TRAP and the population’s exposure.

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Economic Impact from Unrestricted Spread of Potato Cyst Nematodes in Australia

Phytopathology ◽

10.1094/phyto-99-12-1387 ◽

2009 ◽

Vol 99 (12) ◽

pp. 1387-1393 ◽

Cited By ~ 20

Author(s):

M. Hodda ◽

D. C. Cook

Keyword(s):

United States ◽

Confidence Interval ◽

Economic Impact ◽

Annual Cost ◽

The United States ◽

Economic Consequences ◽

Potato Cyst Nematodes ◽

Cyst Nematodes ◽

Model Predictions ◽

Alternative Responses

Potato cyst nematodes (PCN) (Globodera spp.) are quarantine pests with serious potential economic consequences. Recent new detections in Australia, Canada, and the United States have focussed attention on the consequences of spread and economic justifications for alternative responses. Here, a full assessment of the economic impact of PCN spread from a small initial incursion is presented. Models linking spread, population growth, and economic impact are combined to estimate costs of spread without restriction in Australia. Because the characteristics of the Australian PCN populations are currently unknown, the known ranges of parameters were used to obtain cost scenarios, an approach which makes the model predictions applicable generally. Our analysis indicates that mean annual costs associated with spread of PCN would increase rapidly initially, associated with increased testing. Costs would then increase more slowly to peak at over AUD$20 million per year ≈10 years into the future. Afterward, this annual cost would decrease slightly due to discounting factors. Mean annual costs over 20 years were $18.7 million, with a 90% confidence interval between AUD$11.9 million and AUD$27.0 million. Thus, cumulative losses to Australian agriculture over 20 years may exceed $370 million without action to prevent spread of PCN and entry to new areas.

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The Ethics of COVID-19 Vaccine Passports

Ethics & Medics ◽

10.5840/em20214646 ◽

2021 ◽

Vol 46 (4) ◽

pp. 1-2

Author(s):

Joseph Meaney ◽

Keyword(s):

United States ◽

World Health Organization ◽

The United States ◽

Scientific Data ◽

World Health ◽

Medical Decisions ◽

The Poor ◽

Divided Society ◽

The World ◽

Health Organization

COVID-19 vaccine passports run the risk of creating a divided society where social privileges or restrictions based on “fitness” lead to discrimination based on immunization status. Individuals have a strong right to be free of coercion to take a COVID-19 vaccine, and we should be very leery of further invasion of private medical decisions. These concerns are shared both internationally and in the United States, and the World Health Organization, the Biden administration, and many US governors oppose COVID-19 vaccine credentials. In addition, regulations for COVID-19 vaccine credentials face practical barriers, including lack of access globally, especially among the poor; and lack of scientific data on the efficacy of these vaccines.

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The longitudinal health economic impact of viral encephalitis in the United States

Journal of Medical Microbiology ◽

10.1099/jmm.0.001153 ◽

2020 ◽

Vol 69 (2) ◽

pp. 270-279 ◽

Cited By ~ 1

Author(s):

Musa Kiyani ◽

Beiyu Liu ◽

Lefko T. Charalambous ◽

Syed M. Adil ◽

Sarah E. Hodges ◽

...

Keyword(s):

United States ◽

Health Economic ◽

Economic Impact ◽

Viral Encephalitis ◽

The United States

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The Health Economic Impact of Coffee Consumption on Prevention of Chronic Disease and Cancer in the United States

Value in Health ◽

10.1016/j.jval.2014.03.450 ◽

2014 ◽

Vol 17 (3) ◽

pp. A77

Author(s):

K. O’Day ◽

C.M. Campbell ◽

B.V. Popelar ◽

T. McLaughlin

Keyword(s):

United States ◽

Health Economic ◽

Chronic Disease ◽

Economic Impact ◽

Coffee Consumption ◽

The United States

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The Economic Impact of Extensor Tendon Lacerations of the Hand in the United States

Annals of Plastic Surgery ◽

10.1097/sap.0000000000002927 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Raman Mehrzad ◽

Vikram Mookerjee ◽

Scott Schmidt ◽

Chris Jehle ◽

Vinay Rao ◽

...

Keyword(s):

United States ◽

Economic Impact ◽

Extensor Tendon ◽

The United States

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Fully Automatic Treatment Planning for External-Beam Radiation Therapy of Locally Advanced Cervical Cancer: A Tool for Low-Resource Clinics

Journal of Global Oncology ◽

10.1200/jgo.18.00107 ◽

2019 ◽

pp. 1-9

Author(s):

Kelly Kisling ◽

Lifei Zhang ◽

Hannah Simonds ◽

Nazia Fakie ◽

Jinzhong Yang ◽

...

Keyword(s):

United States ◽

South Africa ◽

Cervical Cancer ◽

Treatment Planning ◽

South African ◽

The United States ◽

Ct Scans ◽

Low Resource ◽

Fully Automatic ◽

Automatic Treatment

Purpose The purpose of this study was to validate a fully automatic treatment planning system for conventional radiotherapy of cervical cancer. This system was developed to mitigate staff shortages in low-resource clinics. Methods In collaboration with hospitals in South Africa and the United States, we have developed the Radiation Planning Assistant (RPA), which includes algorithms for automating every step of planning: delineating the body contour, detecting the marked isocenter, designing the treatment-beam apertures, and optimizing the beam weights to minimize dose heterogeneity. First, we validated the RPA retrospectively on 150 planning computed tomography (CT) scans. We then tested it remotely on 14 planning CT scans at two South African hospitals. Finally, automatically planned treatment beams were clinically deployed at our institution. Results The automatically and manually delineated body contours agreed well (median mean surface distance, 0.6 mm; range, 0.4 to 1.9 mm). The automatically and manually detected marked isocenters agreed well (mean difference, 1.1 mm; range, 0.1 to 2.9 mm). In validating the automatically designed beam apertures, two physicians, one from our institution and one from a South African partner institution, rated 91% and 88% of plans acceptable for treatment, respectively. The use of automatically optimized beam weights reduced the maximum dose significantly (median, −1.9%; P < .001). Of the 14 plans from South Africa, 100% were rated clinically acceptable. Automatically planned treatment beams have been used for 24 patients with cervical cancer by physicians at our institution, with edits as needed, and its use is ongoing. Conclusion We found that fully automatic treatment planning is effective for cervical cancer radiotherapy and may provide a reliable option for low-resource clinics. Prospective studies are ongoing in the United States and are planned with partner clinics.

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