15639 Balloon cell melanoma: A National Cancer Institute database analysis of patient characteristics and survival

Context.— The incidence of prostate cancer with Gleason scores 2 through 4 has been decreasing for decades, largely because of evolving criteria for Gleason scores, including the 2005 International Society of Urological Pathology recommendation that scores of 2 through 4 should rarely, if ever, be diagnosed based on needle biopsy. Whether trends in assigning Gleason scores 2 through 4 vary by facility type and patient characteristics is unknown. Objective.— To assess trends in prostate cancer grading among various categories of treatment facilities. Design.— Analyses of National Cancer Database records from 1990 through 2013 for 434 612 prostate cancers diagnosed by core needle biopsy, including multivariable regression for 106 331 patients with clinical T1c disease diagnosed from 2004 through 2013. Results.— The proportion of prostate core needle biopsies with Gleason scores 2 through 4 declined from 11 476 of 53 850 (21.3%) (1990–1994) to 96 of 43 566 (0.2%) (2010–2013). The proportions of American Joint Committee on Cancer category T1c needle biopsies assigned Gleason scores 2 through 4 were 416 of 12 796 (3.3%) and 9 of 7194 (0.1%) during 2004 and 2013, respectively. Declines occurred earliest at National Cancer Institute–designated programs and latest at community programs. A multivariable logistic model adjusting for patient demographic and clinical variables and restricted to T1c cancers diagnosed in needle biopsies from 2004 through 2013 showed that facility type is independently associated with the likelihood of cancers in such specimens being assigned Gleason scores of 2 through 4, with community centers having a statistically significant odds ratio of 5.99 relative to National Cancer Institute–designated centers. Conclusions.— These results strongly suggest differences in Gleason grading by pathologists practicing in different facility categories and variations in their promptness of adopting International Society of Urological Pathology recommendations.

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Patient characteristics and hospitalisation costs of spinal muscular atrophy in Spain: a retrospective multicentre database analysis

BMJ Open ◽

10.1136/bmjopen-2019-031271 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031271

Author(s):

Josep Darbà ◽

Alicia Marsà

Keyword(s):

Disease Management ◽

Spinal Muscular Atrophy ◽

Muscular Atrophy ◽

Indirect Costs ◽

Patient Characteristics ◽

Medical Costs ◽

Hospital Inpatient ◽

Database Analysis ◽

Use Of Resources ◽

The Impact

ObjectivesTo analyse the characteristics of patients diagnosed with spinal muscular atrophy in Spain, and to revise data on disease management and use of resources in both public and private healthcare centres.DesignA retrospective multicentre database analysis.Setting870 admission records registered between 1997 and 2015 with a diagnosis of spinal muscular atrophy were extracted from a Spanish claims database that includes hospital inpatient and outpatient admissions from 313 public and 192 private hospitals in Spain.ResultsAdmission files corresponded to 705 patients; 61.99% were males and 38.01% females. Average patient age was 37 years. Disease comorbidities registered during the admission consistently included hypertension, scoliosis and respiratory failures, all associated with the standard disease course. Regarding disease management at the hospital level, patients were mostly admitted through scheduled appointments (58.16%), followed by emergency admissions (41.72%), and into neurology services in 17% of the cases. Mean hospitalisation time was 10.45 days and in-hospital mortality reached 5.29%. The overall direct medical costs of spinal muscular atrophy were €291 525, excluding medication. The average annual cost per admission was €6274, with large variations likely to reflect disease complexity and that increases with length of stay.ConclusionsThe rarity of the disease difficulties the study of demographics and management; yet, an analysis of patient characteristics provides necessary information that can be used by governments to establish more efficient healthcare protocols. This study reflects the impact that individual needs and disease severity can have in disease burden calculations. Forthcoming decision-making policies should take into account medical costs and its variability, as well as pharmaceutical expenses and indirect costs. To our knowledge, this is the first study evaluating the use of healthcare resources of patients with spinal muscular atrophy in Spain.

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