Surveillance of colorectal cancers following curative-intent surgery: "Whatever the cost?"

AbstractRationaleThe Institute of Medicine emphasizes care in the post-treatment phase of the cancer survivorship continuum. Physical exercise has been shown to be effective in improving physical function and quality of life in cancer survivors; however, its cost-effectiveness in lung cancer survivors is not well established.ObjectiveWe performed a model-based cost-effectiveness analysis of an exercise intervention in lung cancer survivors following curative-intent treatment.MethodsWe constructed a Markov model to simulate the impact of the Lifestyle Interventions and Independence for Elders (LIFE) exercise intervention compared to usual care for stage I-IIIA lung cancer survivors. Costs and utility benefit of exercise were extracted from the LIFE study. Baseline utilities, transition probabilities, and survival were modeled. We calculated and considered incremental cost-effectiveness ratios (ICERs) <$100,000/quality-adjusted life-year (QALY) as cost-effective, and assessed model uncertainty using one-way and probabilistic sensitivity analyses.ResultsOur base-case model found that the LIFE exercise program would increase overall cost by $4,740 and effectiveness by 0.06 QALYs compared to usual care, and have an ICER of $79,504/QALY. The model was most sensitive to the cost of the exercise program, probability of increasing exercise, and utility benefit related to exercise. At a willingness-to-pay threshold of $100,000/QALY, the LIFE exercise program had a 71% probability of being cost-effective compared to 27% for usual care. When we included opportunity costs, the LIFE exercise program had an ICER of $179,774/QALY, exceeding the cost-effectiveness threshold.ConclusionsA simulation of the LIFE exercise program in lung cancer survivors following curative-intent treatment demonstrates cost-effectiveness from an organization but not societal perspective. Strategies to effectively increase exercise remotely may be more cost-effective than in-facility strategies for these patients.

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The cost of one added day of survival by targeted therapy in metastatic colorectal cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.421 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 421-421

Author(s):

Helmy M. Guirgis

Keyword(s):

Colorectal Cancer ◽

Targeted Therapy ◽

Metastatic Cancer ◽

Colorectal Cancers ◽

Survival Gain ◽

Background Data ◽

Number Of Cycles ◽

The Cost ◽

The Impact ◽

Objective Study

421 Background: Data was collected to assess the cost of one day of added survival over control in metastatic cancer. Aflibercept and regorafenib have been approved as last resort treatments in refractory colorectal cancer (mCRC). Objective: Study the impact of number of cycles on overall survival gain (OSg) in refractory and first-line mCRC. Methods: Average Wholesale Prices in United States dollars (US$) of evaluated drugs and ancillary costs were added. The total was divided by reported median OSg in days. Plans were designed to rate and score drugs. Results: See Table. The data was collected to share with physicians, patients, and authorities, not for drug comparison. Conclusions: The cost of one-day survival gain by aflibercept and regorafenib was relatively high. Increased number of cycles of targeted therapy increased cost/OSg and decreased ratings and scores. [Table: see text]

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Estimating the benefit and cost of radiotherapy for lung cancer

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462304001485 ◽

2004 ◽

Vol 20 (4) ◽

pp. 545-551 ◽

Cited By ~ 19

Author(s):

Lisa Barbera ◽

Hugh Walker ◽

Farshad Foroudi ◽

Scott Tyldesley ◽

William Mackillop

Keyword(s):

Lung Cancer ◽

Symptom Control ◽

Small Cell ◽

Curative Intent ◽

Initial Management ◽

Palliative Intent ◽

Cancer Registry Data ◽

The Mean ◽

The Cost ◽

Indication For Treatment

Purpose: To estimate the benefit and cost of using radiotherapy (RT) in the initial management of lung cancer in the general population.Methods: We identified indications for RT in the initial management of small cell and non–small cell lung cancer through a review of the literature. The proportion of patients with each specific indication for treatment was determined using epidemiological observations from cancer registry data and from the literature. We estimated the benefit gained from RT use for each indication in the model using values published in the literature. We estimated the cost of RT for each indication using published Canadian data. The total benefit and cost was calculated for all indications combined. Results are reported in 2001 Canadian dollars.Results: The mean benefit was 7 months of survival for each lung cancer patient treated with curative intent and 3 months of symptom control for each patient treated with palliative intent. The average cost was $9,881 per life year gained and $13,938 per year of symptom control gained. Sensitivity analysis revealed values between $7,905 and $19,762 per year of survival gain and between $10,368 and $27,875 per year of symptom control gained.Conclusions: Using RT in the initial management of lung cancer can provide considerable gains in survival and symptom control. The cost of RT for the initial management of lung cancer is inexpensive compared with a common cut off of $50,000 per life year gained.

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Lymph Node Harvest in Dukes' A Cancer Pathologist May Need to Consider Fat Dissolving Technique: An Observational Study

The Scientific World JOURNAL ◽

10.1100/2012/919464 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

A. P. Saklani ◽

T. Udy ◽

T. V. Chandrasekaran ◽

M. Davies ◽

J. Beynon

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Colorectal Resection ◽

Clinical Excellence ◽

Median Number ◽

Colorectal Cancers ◽

Curative Intent ◽

Lymph Node Harvest ◽

Intent To Treat ◽

Standard Techniques

Background. National institute of clinical excellence (NICE) recommends that a median of 12 lymph nodes be examined in patients operated on with curative intent- to- treat colorectal cancer (CRC). Patients with lymph node harvest less than this may be considered under staged and may receive adjuvant chemotherapy. The aim of our study was to ascertain median number of lymph nodes examined in early colorectal cancers.Method. Patients undergoing colorectal resection between June 2007 and May 2008 were identified and pathological staging obtained using pathology database.Results. 146 patients underwent standardised laparoscopic or open resection of colorectal cancers during this period. Overall median number of lymph nodes harvested/patient was 14 (3–40). When analysed by stage, median number of lymph nodes harvested in Dukes' A, B, and C cancers was 10, 14, and 15, respectively. 11/18 (61%) patients with Dukes’ A carcinoma had lymph node harvest of less than 12 compared with 15/55 (27%) patients with Dukes’ B.Conclusion. Lymph node harvest in Dukes' A cancers using standard techniques tends to be low. Pathologists may have to consider special techniques in harvesting lymph nodes for early colorectal cancers.

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Early Detection of Cancer: Past, Present, and Future

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2015.35.57 ◽

2015 ◽

pp. 57-65 ◽

Cited By ~ 46

Author(s):

Joshua D. Schiffman ◽

Paul G. Fisher ◽

Peter Gibbs

Keyword(s):

Cancer Screening ◽

Circulating Tumor Dna ◽

Screening Tests ◽

Current Status ◽

Screening Methods ◽

Clinical Consequence ◽

Curative Intent ◽

High Risk Populations ◽

Early Tumor ◽

The Cost

Screening in both healthy and high-risk populations offers the opportunity to detect cancer early and with an increased opportunity for treatment and curative intent. Currently, a defined role for screening exists in some cancer types, but each screening test has limitations, and improved screening methods are urgently needed. Unfortunately, many cancers still lack effective screening recommendations, or in some cases, the benefits from screening are marginal when weighed against the potential for harm. Here we review the current status of cancer screening: we examine the role of traditional tumor biomarkers, describe recommended imaging for early tumor surveillance, and explore the potential of promising novel cancer markers such as circulating tumor cells (CTC) and circulating tumor DNA. Consistent challenges for all of these screening tests include limited sensitivity and specificity. The risk for overdiagnosis remains a particular concern in screening, whereby lesions of no clinical consequence may be detected and thus create difficult management decisions for the clinician and patient. If treatment is pursued following overdiagnosis, patients may be exposed to morbidity from a treatment that may not provide any true benefit. The cost-effectiveness of screening tests also needs to be an ongoing focus. The improvement of genomic and surveillance technologies, which leads to more precise imaging and the ability to characterize blood-based tumor markers of greater specificity, offers opportunities for major progress in cancer screening.

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The IBM-PC in electron microscopy

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100165525 ◽

1996 ◽

Vol 54 ◽

pp. 612-613

Author(s):

James F. Mancuso

Keyword(s):

Head Start ◽

Image Acquisition ◽

Cost Effective ◽

Financial Applications ◽

Number Of Factors ◽

Instrument Control ◽

The Cost ◽

Training And Support ◽

Control Image ◽

Ibm Pc

IBM PC compatible computers are widely used in microscopy for applications ranging from control to image acquisition and analysis. The choice of IBM-PC based systems over competing computer platforms can be based on technical merit alone or on a number of factors relating to economics, availability of peripherals, management dictum, or simple personal preference.IBM-PC got a strong “head start” by first dominating clerical, document processing and financial applications. The use of these computers spilled into the laboratory where the DOS based IBM-PC replaced mini-computers. Compared to minicomputer, the PC provided a more for cost-effective platform for applications in numerical analysis, engineering and design, instrument control, image acquisition and image processing. In addition, the sitewide use of a common PC platform could reduce the cost of training and support services relative to cases where many different computer platforms were used. This could be especially true for the microscopists who must use computers in both the laboratory and the office.

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New Feasible Concepts of Aberration Correction for Realizing High-Resolution Electron Microscopes

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100179762 ◽

1990 ◽

Vol 48 (1) ◽

pp. 202-203

Author(s):

H. Rose

Keyword(s):

Spherical Aberration ◽

Wave Length ◽

Electron Wave ◽

Optical Lens ◽

Resolution Electron ◽

Rotationally Symmetric ◽

Electron Microscopes ◽

The Cost ◽

Imaging Performance ◽

Acceleration Voltage

The imaging performance of the light optical lens systems has reached such a degree of perfection that nowadays numerical apertures of about 1 can be utilized. Compared to this state of development the objective lenses of electron microscopes are rather poor allowing at most usable apertures somewhat smaller than 10-2 . This severe shortcoming is due to the unavoidable axial chromatic and spherical aberration of rotationally symmetric electron lenses employed so far in all electron microscopes.The resolution of such electron microscopes can only be improved by increasing the accelerating voltage which shortens the electron wave length. Unfortunately, this procedure is rather ineffective because the achievable gain in resolution is only proportional to λ1/4 for a fixed magnetic field strength determined by the magnetic saturation of the pole pieces. Moreover, increasing the acceleration voltage results in deleterious knock-on processes and in extreme difficulties to stabilize the high voltage. Last not least the cost increase exponentially with voltage.

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