scholarly journals PCN135 CONTROLLING THE COST OF CARE OF BREAST CANCER PATIENTS IN GERMANY USING CLINICAL PATHWAYS

2010 ◽  
Vol 13 (3) ◽  
pp. A49
Author(s):  
C Bosch ◽  
S Vogel ◽  
M Schrappe ◽  
E-M Grischke ◽  
I Seyfarth-Metzger ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Clinical Pathways ◽  
Cost Of Care ◽  
Breast Cancer Patients ◽  
The Cost

Growth factor use and rate of neutropenic complications in breast cancer patients treated with dose-dense paclitaxel: A 5-year experience from a safety net hospital.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6527-6527
Author(s):  
Racha Halawi ◽  
Kavi Patel ◽  
Ethan Tobias ◽  
Samira K. Syed ◽  
Nisha Unni ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Growth Factor ◽  
Cancer Patients ◽  
Safety Net ◽  
Cost Of Care ◽  
Breast Cancer Patients ◽  
Safety Net Hospital ◽  
Grade 3 ◽  
Dose Dense ◽  
The Cost

6527 Background: The NCCN guidelines recommend growth factor (G-CSF) support to reduce the risk of febrile neutropenia and maintain dose density in patients receiving dose dense chemotherapy. We retrospectively reviewed growth factor utilization with dose dense paclitaxel (ddT) in breast cancer patients treated at our institution. Methods: Electronic medical records of patients treated at Parkland Health and Hospital System between 2012-2017 for breast cancer with dose dense adriamycin and cyclophosphamide (ddAC) followed by ddT were reviewed. Data on patient characteristics as well as G-CSF use and neutropenic complications were collected. Results: Two-hundred sixty eight patients received a total of 1019 cycles of ddT. Only one physician in the practice routinely prescribed G-CSF after ddT. The majority of ddT cycles were administered without G-CSF support (781 vs 238 cycles). There were no episodes of neutropenic fever in either group. The rate of grade 3/4 neutropenia was 2.1 % with G-CSF support (all grade 3), and 2.7% without G-CSF support (85% grade 3), p = 0.61. Treatment delays were longer in patients who did not receive G-CSF support, but this difference was not statistically significant (mean of 4 vs 2.2 days, p = 0.07). The number of cycles needed to treat to prevent 1 episode of grade 3/4 neutropenia was 167. Based on Medicare average sales price (ASP) for pegfilgrastim, routine use of G-CSF in our patient population would have added over $3.6M to the cost of care over the study period. Conclusions: Our results show a similarly low rate of neutropenic complications in patients receiving dose dense paclitaxel with or without G-CSF support. Therefore routine use of G-CSF with this regimen is not warranted. Judicious use of expensive medications such as G-CSF would reduce the cost of care and financial toxicity to patients, and promote high value care.

The efficacy of axillary ultrasound in the detection of nodal metastasis in breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e21137-e21137
Author(s):  
Belinda Lee ◽  
Adrian K. Lim ◽  
Jonathan Krell ◽  
Keshthra Satchithananda ◽  
Jacqueline S Lewis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Cortical Thickness ◽  
Predictive Value ◽  
Clinical Pathways ◽  
Axillary Node ◽  
Breast Cancer Patients ◽  
Nodal Involvement ◽  
Axillary Ultrasound

e21137 Background: Recent reports indicate a lack of survival benefit for axillary node dissection (ALND) versus sentinel lymph node biopsy in early breast cancer. To study this further we assessed the accuracy and effectiveness of ultrasound in detecting axillary nodal involvement in breast cancer patients, aimed at refining and evaluating our current clinical pathways as newly diagnosed invasive breast cancer patients routinely undergo pre-surgical axillary ultrasound. Methods: Ultrasound data were collected from consecutive breast cancer cases over 3 years. Images were reviewed by experienced radiologists and made the following assessments on size, morphology, fatty hilum and cortical thickness of the ipsilateral axillary nodes. The findings were correlated with histology outcomes following ALND. Results: 260 cases were included in the analysis, 113 (43.5%) had evidence of metastatic nodal involvement at final histology. Of these, 59/113 (52.2%) reported positive findings on ultrasonography. The overall positive predictive value of ultrasound for detecting metastatic nodal involvement measured 0.70. The negative predictive value was 0.61. The sensitivity was 52%, specificity measured 78% and the accuracy was 65%. The ultrasound morphological lymph node features with the greatest correlation with malignancy were absence of a fatty hilum (p=0.003) and increased cortical thickness (p=0.03). Cases with a metastatic nodal burden density of a least 20% were more likely to report an abnormal axillary ultrasound. (p=0.009). Conclusions: Axillary ultrasound has a low NPV and negative sonographic results do not exclude axillary node metastases with sufficient sensitivity, to justify its routine clinical use. Clinical pathways need to consider an evidence-based approach, focusing on the criteria by which we select breast cancer patients for axillary nodal dissection.

The cost-effectiveness of a nurse-led care program for breast cancer patients undergoing outpatient-based chemotherapy – A feasibility trial

2018 ◽  
Vol 36 ◽  
pp. 16-25 ◽  
Author(s):  
Xiao Bin Lai ◽  
Shirley Siu Yin Ching ◽  
Frances Kam Yuet Wong ◽  
Carenx Wai Yee Leung ◽  
Lai Ha Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Cancer Patients ◽  
Care Program ◽  
Feasibility Trial ◽  
Breast Cancer Patients ◽  
The Cost

scholarly journals Healthcare utilization and cost of care in elderly breast cancer patients enrolled in SWOG clinical trials

2020 ◽  
Vol 181 (2) ◽  
pp. 455-463 ◽  
Author(s):  
Dawn L. Hershman ◽  
Cathee Till ◽  
Jason D. Wright ◽  
Melissa Accordino ◽  
Riha Vaidya ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Cancer Patients ◽  
Healthcare Utilization ◽  
Cost Of Care ◽  
Breast Cancer Patients

Docetaxel in Combination With Doxorubicin and Cyclophosphamide As Adjuvant Treatment for Early Node-Positive Breast Cancer: A Cost-Effectiveness and Cost-Utility Analysis

2008 ◽  
Vol 26 (6) ◽  
pp. 925-933 ◽  
Author(s):  
Sorrel E. Wolowacz ◽  
David A. Cameron ◽  
Helen C. Tate ◽  
Adrian Bagust
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cancer Patients ◽  
Early Breast Cancer ◽  
Breast Cancer Patients ◽  
Data Set ◽  
Node Positive ◽  
International Research Group ◽  
The Cost

Purpose To estimate the cost effectiveness of TAC (docetaxel, doxorubicin, and cyclophosphamide) compared with FAC (fluorouracil, doxorubicin, and cyclophosphamide) when administered as adjuvant therapy to women with node-positive early breast cancer in the United Kingdom (UK), both with and without primary prophylaxis with granulocyte colony-stimulating factor (G-CSF). Methods A standard health economic Markov model estimated the cost and outcome for node-positive early breast cancer patients, from initiation of adjuvant chemotherapy to death. Patient-level data were used from the Breast Cancer International Research Group (BCIRG) 001 trial for estimates of the effect of chemotherapy on toxicity and outcome, and an observational data set collected from a UK university hospital provided estimates of resource use and outcome for patients with relapsed disease. Results Over a 10-year analysis timeframe, the incremental cost per life-year saved associated with the use of TAC rather than FAC was estimated as £15,418 (95% CI, £13,734 to £17,997) and the incremental cost per quality-adjusted life-year gained (IC/QALY) was £18,188 (95% CI, £14,161 to £32,422). The addition of primary G-CSF (lenograstim or filgrastim) to the TAC regimen resulted in an IC/QALY of £20,432. The results were most sensitive to the quality-of-life (QOL) score for patients in remission postchemotherapy. However, even if QOL was assumed to be as poor as for patients with metastatic disease, the IC/QALY estimate rose only to £32,430. Conclusion The use of adjuvant TAC rather than FAC for node-positive early breast cancer patients is cost effective, despite the increased drug and toxicity treatment costs, and when primary G-CSF prophylaxis is given to all patients.

Resource and quality information provided by compliance with NCCN hereditary breast cancer guidelines.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 5-5
Author(s):  
Peter J. Levonian ◽  
Jeffrey Landercasper ◽  
Choua Vang ◽  
Kristen Marcou ◽  
Rima Al Hajj ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Genetic Counseling ◽  
Cancer Patients ◽  
Compliance Rate ◽  
Cost Of Care ◽  
Breast Cancer Patients ◽  
Brca Testing ◽  
Genetic Risk Assessment ◽  
Nccn Guidelines ◽  
Assessment And Testing

5 Background: NCCN provides guidelines for breast cancer genetic risk assessment and testing. Measuring compliance with NCCN Guidelines (NG) can identify quality gaps. Methods: After IRB approval, a retrospective review of a prospective database of breast cancer patients was conducted to measure compliance with NG for genetic counseling and BRCA testing. Entry criteria were breast cancer patients with diagnosis and treatment at our center, during the 3 year period ending 12/31/11. Genetic counselors (GC) used NG and BRCAPRO modeling in all patients. Surgeon and GC pedigree analyses were compared. Results: Surgeons constructed pedigrees in 675 breast cancer patients and referred 42% (286/675) to the GC. The decision to refer was NCCN compliant in 671/675 (99%). The GC corrected the pedigree in 14% (39/286); nearly all due to the GC identifying extra breast or ovarian cancers. The mean BRCAPRO probability in referred patients was 7.2%. Fifty-nine percent (170/286) of patients seen by the GC received a recommendation for BRCA testing. The NG compliance rate for testing was 98% (170/174). Of 174 BRCA tests offered to patients, 74% (128/174) underwent testing. In tested patients, there were 4% BRCA1+, 5% BRCA 2+, and 1% uncertain variants. Total patient charges for 128 tests were $696,000 ($4,000/test). If the threshold for testing was BRCAPRO > 5% or >10%, then 69 ($276,000) and 45 ($180,000) (p<0.001) patient charges would have occurred, and no patient with BRCA + status would have been missed. Conclusions: High rates of NCCN guideline compliance for genetic counseling and testing are achievable. Our GC's improve accuracy of pedigree assessment and demonstrate adherence to NCCN guidelines, resulting in more testing compared to BRCAPRO modeling. The balance between different methods to trigger testing, their sensitivity, and cost deserves more study, but the observational data contained herein provides information for provider and payer stakeholders regarding estimated GC resources and cost of care.

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