Optimising health economic evaluations for geriatric cancer patients

2017 ◽  
Vol 23 (03) ◽  
pp. 123-128
Author(s):  
Andrea Goettler ◽  
Tanja-Maria Kessel ◽  
Diana Sonntag
Keyword(s):  
Health Economic ◽  
Elderly Patients ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Geriatric Patients ◽  
The Elderly ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Cost Calculation ◽  
Geriatric Cancer

Abstract Aim Despite the growing number of elderly cancer patients, health economic evaluations have not put enough attention on this patient group. We reflect on the current state of health economic evaluations for geriatric patients and present suggestions for improvements. Method We reviewed the scientific literature on health economic evaluations for geriatric patients in Germany and internationally. Additionally, we conducted a scoping review on cost-utility analyses on cancer treatment for older patients (> 60 years). Results The literature review resulted in eight relevant studies. Besides the paucity of economic evaluations for elderly patients, we also present quality limitations. From the literature, we identify four recommendations regarding cost calculation, geriatric assessment, patient decision-making and quality of life on how to design better economic evaluations for geriatric cancer treatment. Conclusion The demographic change requires more attention regarding elderly patients in health economics. Including patients above 70 years of age in health economic evaluations and improving cost-utility analyses will help to improve resource allocations and effective healthcare for the elderly.

scholarly journals Health economic measures in schizophrenia research

2007 ◽  
Vol 191 (S50) ◽  
pp. s42-s45 ◽  
Author(s):  
Paul McCrone
Keyword(s):  
Health Economic ◽  
Economic Evaluation ◽  
Cost Utility ◽  
Outcome Data ◽  
Cost Utility Analysis ◽  
Economic Evaluations ◽  
Utility Analysis ◽  
Short Term ◽  
Effectiveness Analysis

BackgroundIt is essential in economic evaluations of schizophrenia interventions that all relevant costs are identified and measured appropriately Also of importance is the way in which cost data are combined with information on outcomesAimsTo examine the use of health economicsin evaluations of interventions for schizophreniaMethodsAreview of the key methods used to estimate costs and to link costs and outcomes was conductedResultsCosts fall on a number of different agencies and can be short term or long term. Cost-effectiveness analysis and cost-utility analysis are the most appropriate methods for combing cost and outcome dataConclusionsSchizophrenia poses a number of challenges for economic evaluation

scholarly journals Predictors of Noncompletion of Cancer Treatments in Elderly Patients: the Elderly Cancer Patients (Elcapa) Cohort Study

2012 ◽  
Vol 23 ◽  
pp. ix452
Author(s):  
M. Laurent ◽  
E. Paillaud ◽  
M. Carvalho-Verlinde ◽  
P. Caillet ◽  
A. Le Thuaut ◽  
...  
Keyword(s):  
Cohort Study ◽  
Elderly Patients ◽  
Cancer Patients ◽  
The Elderly ◽  
Cancer Treatments ◽  
Elderly Cancer Patients

Clinical and pathological characteristics of elderly colorectal cancer patients over 70 years old and comparison with patients under 50 years old.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14174-e14174
Author(s):  
Betul Erismis ◽  
Nadire Kucukoztas ◽  
Samed Rahatli ◽  
Selim Yalcin ◽  
Omer Dizdar ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Systemic Disease ◽  
Performance Status ◽  
The Elderly ◽  
University Hospital ◽  
Individual Treatment ◽  
Pathological Characteristics ◽  
Colorectal Cancer Patients

e14174 Background: Incidence of colon cancer increases with age and generally is diagnosed at the age of between 60-75. Because of comorbidities in elderly patients who are older 70 years of age, lower doses of adjuvant or metastatic therapy is given them or the other option can be the chemotherapeutics which had less side effects. Methods: We aim to identify clinical and pathological characteristics of elderly colorectal cancer patients over 70 years of age who were followed at Baskent University Hospital and compare with CRC patients under the 50 years of age. Results: 182 CRC patients were assigned to the study who were followed between 1998-2011. We classified the patients into two categories according to the age. 91 participants were over 70 years of age and 91 participants were under 50 years of age. There were no significant differences between two groups for gender and percentage of patients having surgery (p=0.65/0.732). History of having systemic disease was significantly higher in the elderly group (p<0.001). Adjvuvant chemotherapy was given to the 38 (53.5%) patients aged over 70 and 66 (91.7%) patients aged under 50 (p<0.001). We compared the both groups for progression free and overall survival time for all stages. However, there were no statistically significant differences between two groups. Conclusions: Our study confirms that elderly CRC patients get benefit from the adjuvant chemotherapy treatment as the same as patients under 50 years of age. Therefore, physcians should consider about performance status and systemic disease in elderly patients and give an individual treatment to them.

scholarly journals TRENDS AND OPPORTUNITIES IN HEALTH ECONOMIC EVALUATIONS OF PROSTHETIC CARE INNOVATIONS

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Laurent Frossard
Keyword(s):  
Health Economic ◽  
Collaborative Design ◽  
Health Economic Evaluation ◽  
Economic Benefits ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Utility Analysis ◽  
Stage Of Development ◽  
Basic Framework ◽  
Substantial Economic Burden

Overcoming obstacles to prosthetic fittings requires frequent tryouts of sockets and components. Repetitions of interventions are upsetting for users and place substantial economic burden on healthcare systems. Encouraging prosthetic care innovations capable of alleviating clinical and financial shortcomings of socket-based solutions is essential. Nonetheless, evidence of socio-economic benefits of an innovation are required to facilitate access to markets. Unfortunately, complex decisions must be made when allocating resources toward the most relevant health economic evaluation (HEE) at a given stage of development of an innovation. This paper first, aimed to show the importance and challenges of HEEs of intervention facilitating prosthetic fittings. Next, the main trends in HEEs at various phases of product development and clinical acceptance of prosthetic care innovations were outlined. Then, opportunities for a basic framework of a preliminary cost-utility analysis (CUA) during the mid-stage of development of prosthetic care innovations were highlighted. To do this, fundamental and applied health economic literature and prosthetic-specific publications were reviewed to extract and analyse the trends in HEEs of new medical and prosthetic technologies, respectively. The findings show there is consensus around the weaknesses of full CUAs (e.g., lack of timeliness, resource-intensive) and strengths of preliminary CUAs (e.g., identify evidence gaps, educate design of full CUA, fast-track approval). However, several obstacles must be overcome before preliminary CUA of prosthetic care innovations will be routinely carried out. Disparities of methods and constructs of usual preliminary CUA are barriers that could be alleviated by a more standardized framework. The paper concludes by identifying that there are opportunities for the development of a basic framework of preliminary CUA of prosthetic care innovations. Ultimately, the collaborative design of a framework could simplify selection of the methods, standardise outcomes, ease comparisons between innovations and streamline pathways for adoption. This might facilitate access to economical solutions that could improve the life of individuals suffering from limb loss.   Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36364/28327 How To Cite: Frossard L. Trends and opportunities in health economic evaluations of prosthetic care innovations. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.9. https://doi.org/10.33137/cpoj.v4i2.36364 Corresponding Author: Laurent Frossard, PhD, Professor of BionicsYourResearchProject Pty Ltd, Brisbane, Australia.E-Mail: [email protected] number: https://orcid.org/0000-0002-0248-9589

scholarly journals Cancer Treatment Among the Elderly in the United States: Complexities of Aging and Comorbidities

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 108s-108s
Author(s):  
T. Pham ◽  
S. Jiang ◽  
A. Rositch
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Multivariable Analysis ◽  
The Elderly ◽  
The United States ◽  
Lung Cancer Patients ◽  
Comorbidity Burden ◽  
Breast And Prostate Cancer

Background: As the life expectancy of Americans becomes longer, the number of individuals who are diagnosed with cancer and other comorbidities increases rapidly. Management of these patients can become increasingly complicated as physicians administer multiple combinations of drugs and therapies. However, the complexities of how age and comorbidities affect receipt of cancer treatment are not well understood. Aim: To explore the association between age, comorbidities, and subsequent cancer treatment in the elderly diagnosed with the four most common types of cancer in the United States. Methods: We used SEER-Medicare data, which covers 28% of the U.S. population, to explore the association between age, comorbidities, and receipt of cancer treatment within 6 months of diagnosis in 727,136 individuals over 65 years old and diagnosed with breast, colorectal, lung, and prostate cancer from 1992-2011. Comorbidity burden was measured using the Charlson Comorbidity Index (CCI) and analyzed as four quantities (Q1: lowest CCI score to Q4: highest CCI score). Poisson regression models were used to assess the associations between comorbidities and cancer treatment, and whether age modified this relationship. Results: Cancer treatment proportion declined rapidly with age for all cancers while median CCI scores increased with age among breast, colorectal, prostate cancer patients and appeared stable among lung cancer patients. For example, individuals aged 76-99 had higher CCI scores ( P < 0.001) and were less likely to be treated (69.8% vs. 81.1% of those age 66-75 year; P < 0.001). After adjustment for potential confounders, we found that high CCI scores (Q3-Q4) were associated with substantially lower cancer treatment rates compared to low CCI score (Q1) in all cancer patients aged 76-99. Regarding individuals aged 66-75, high CCI scores (Q3-Q4) were not associated with lower colorectal cancer treatment rates, and only the highest CCI score group (Q4) was associated with a modest reduction in breast and prostate cancer treatment rates compared to low CCI score (Q1) (PR [95% CI]: 0.97 [0.95-0.99] and 0.91 [0.88-0.93], respectively). Additional multivariable analysis showed that older patients (aged 76-99) with low CCI score (Q1-Q2) had equal or lower treatment rates compared to younger patients (aged 66-75) with the highest CCI scores (Q4). Conclusion: Our findings suggested that among those aged 66-75 years, comorbidities are less likely to influence the receipt of treatment when compared to individuals aged 76-99. The potential harms and benefits of treatment given these age by comorbidity interactions are not clear, but using curative interventions that only have a modest benefit in a highly comorbid aging population could potentially decrease patients' quality of life.

scholarly journals Thyroid cancer surgery in the elderly: a comparative study of 1176 patients

2018 ◽  
Vol 5 (6) ◽  
pp. 2000
Author(s):  
Omer Parlak ◽  
Fatma Dilek Dellal ◽  
Serap Ulusoy ◽  
Ibrahim Kılınc
Keyword(s):  
Thyroid Cancer ◽  
Elderly Patients ◽  
Geriatric Patients ◽  
The Elderly ◽  
Cancer Surgery ◽  
Cancer Type ◽  
Capsular Invasion ◽  
Significant Difference ◽  
Surgery In The Elderly ◽  
Male Patients

Background: The aim of this study is to compare the results of patients who were treated with two groups (under 65 years and over 65 years) of thyroid cancer.Methods: A retrospective review of 1176 patients undergoing thyroid cancer surgery between January 2007 and December 2016 was performed. Patients were grouped as ≥65 (geriatric group) and <65 years (non-geriatric group).Results: A total of 139 patients (11.8%) were over 65 years of age and 1037 patients (88.2%) were under 65 years of age. There were 104 female (74.8%) and 35 (25.2%) male patients in the geriatric group. In the non-geriatric group, 917 (78%) patients were female and 259 (22%) were male (p = 0.39). FNAB showed a significant increase in malignant potential in the elderly (p = 0.005). In our series, malignant differences between geriatric and non-geriatric groups are less pronounced among thyroid carcinomas other than capsular invasion. Although there was no significant difference in histopathologic examination, malignant cytology was higher in the elderly patients. There was no significant difference between the young and elderly patients in terms of complication.Conclusions: In this study, papillary Thyroid Ca (PTC) was found to be the most common type of cancer and we could not find any difference in cancer type distribution in geriatric and non-geriatric patients. Total/near total thyroidectomy in experienced hands is safe for elderly patients. There is no difference in terms of complication.

Risk factors for hospitalization in elderly cancer patients receiving chemotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9035-9035
Author(s):  
J. M. Kleiner ◽  
E. Culakova ◽  
D. C. Dale ◽  
J. Crawford ◽  
M. S. Poniewierski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Solid Tumors ◽  
Univariate Analysis ◽  
The Elderly ◽  
Hematologic Toxicity ◽  
Elderly Age ◽  
Elderly Cancer Patients ◽  
Increased Risk

9035 Background: Chemotherapy-associated hospitalization is a major source of morbidity and cost in cancer care, particularly for elderly (age ≥ 65) cancer patients. Hospitalization in the elderly often leads to an irreversible decline in functional status unrelated to the acute event that prompted hospital admission. Currently, little is known about the risk factors that may lead to increased risk of hospitalization in elderly patients receiving chemotherapy (CTX). Methods: 871 patients with solid tumors or lymphoma initiating a new CTX regimen were prospectively enrolled at 60 randomly selected US community oncology sites between 8/2004 and 10/2005. Of these, 361 elderly patients aged 65–91 were identified and followed. Primary endpoint of this investigation was hematologic toxicity and hospitalization was secondary. Pre- CTX patient data were analyzed for increased risk of hospitalization in univariate analysis using the chi-square test. Results: A total of 155 (18%) patients were hospitalized resulting in 215 hospitalizations. Median time to first hospitalization was the second cycle of CTX. 81/361 (22%) of elderly patients were hospitalized compared to only 74/510 (15%) of younger patients (p=0.003). The rate of hospitalization increased in a linear fashion between ages 65–80. Reasons for hospitalization in the elderly included infection, fever, or febrile neutropenia (36%), cardiopulmonary disease (CPD) (12%), vomiting or dehydration (13%), other gastrointestinal (11%), transfusion (8%), thrombosis (4%), CTX administration (4%), and other (13%). Major independent pre-CTX factors that predicted hospitalization in the elderly included male gender (p=0.0004), hemoglobin <11 g/dL (p=0.02), abnormal platelet count (<150k or >350k) (p=0.05), CPD (p=0.03), creatinine >1.5 mg/dL (p=0.05), and ≥ 2 concomitant medications (p=0.0008). Elderly patients with lung cancer (p=0.001) and lymphoma (p=0.05) had significantly higher rates of hospitalization when compared to other solid tumors. Conclusions: These data suggest that the risk of hospitalization increases in elderly cancer patients with age and that pre-CTX factors may be useful in identifying a subpopulation at increased risk for hospitalization. No significant financial relationships to disclose.

Features of clinical course of vulva cancer in reproductive patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15519-e15519
Author(s):  
Ekaterina Nerodo ◽  
Galina A. Nerodo
Keyword(s):  
Elderly Patients ◽  
Cancer Patients ◽  
Clinical Course ◽  
Young Patients ◽  
The Elderly ◽  
Reproductive Age ◽  
Free Survival ◽  
Early Stages ◽  
The One ◽  
Vulva Cancer

e15519 Background: The significant increase of vulva cancer patients in young and middle age is observed during the last ten years. Methods: To compare the clinical course of vulva cancer in reproductive patients (under 50 years of age) with the one in elderly agewe performed the comparative analysis of clinical characteristics of 839 vulva cancer patients, aged 20-90, with stages I-IV carcinoma who underwent standard complex antitumour treatment. Results: The reproductive group included 64 patients (7.6%), 775 patients (92.4%) were over 50 years. These included prevailed groups of 61-70 years of age – 38% and 71-80 years of age – 34%. Early stages of the disease were observed in 48% of all cases, st. III-IV – in 52%. In the reproductive group st. I was observed in 18.75%, st. II – 51.56%, st. III – 23.43%, st. IV – 6.25%. 70.03% patients of reproductive age had early stages of the disease, that is significantly higher than in the group of elderly patients: 51-70 years of age – 55%, 71-80 years of age – 40%, more than 80 years of age – only 25%(p<0.05). Age characteristics of vulva cancer patients in reproductive group were the following: 20-30 years of age – 10.9%, 31-40 years of age – 32.8%, 41-50 years of age – 56.25%. Organ-preserving operations carried out according to strict individual indications were performed to 35 sexually active patients in early stages. Relapses of the disease were revealed in 11 patients out of 64 (17%) in the reproductive group, and in 180 out of 775 (23.2%) patients in the elderly group(p<0,05) Relapses occurred in 8% of reproductive patients with st. I of the disease, st. II – 9%, st. III – 46%. Med locoregional free-survival was in st.I-72,3 mon. ,in st. II-61,3 mon., in st III-17,3 mon. All patients with inoperable tumour relapse underwent chemotherapy with subsequent tumour removal. Conclusions: Vulva cancer in patients of reproductive age is revealed in early stages more often that in elderly patients. There is a possibility to perform organ-preserving operations in young patients, which doesn't lead to relapse increase.

Quality appraisal of pediatric health economic evaluations

2005 ◽  
Vol 21 (2) ◽  
pp. 203-210 ◽  
Author(s):  
Wendy J. Ungar ◽  
Maria T. Santos
Keyword(s):  
Health Economic ◽  
Economic Evaluation ◽  
Target Population ◽  
Poor Quality ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Global Rating ◽  
Quality Appraisal ◽  
Pediatric Health ◽  
Economic Methods

Objectives: This study was undertaken to appraise the quality of published pediatric economic evaluations.Methods: Two independent reviewers appraised 149 randomly selected pediatric health economic studies. Data were collected from full economic evaluations published between 1980 and 1999. Economic evaluations of interventions, programs, and services aimed at neonates to adolescents were included. The Pediatric Quality Appraisal Questionnaire (PQAQ) was used for appraisal. The PQAQ is a 57-item instrument with 13 domains scored from 0 to 1 and one descriptive domain, each corresponding to a key aspect of health economic methodology. The primary outcome was the score for each domain. Additional analyses examined the global rating, the distribution of analytic technique, and the association between domain score and analytic technique.Results: A total of 38 percent of publications were very good to excellent, whereas 43 percent were fair or worse. Although the Discounting, Target Population, Economic Evaluation, Conclusions, and Comparators domains exhibited good quality (0.74 to 0.78), the papers were of poor quality for Conflict of Interest, Incremental Analysis, and Perspective (0.32 to 0.39). Analytic technique was a significant predictor of quality for study design-related domains, with cost-utility analyses demonstrating the highest domain scores.Conclusions: Domains closely related to the elements of economic evaluation demonstrated medium to high quality. However, domains related to analysis fared poorly and are worthy of further methodological research to improve the use of health economic methods in children.

Sign in / Sign up

Export Citation Format

Share Document