Economic Burden of Hematologic Adverse Events in Cancer Patients Undergoing Chemotherapy: A Systematic Review.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3350-3350
Author(s):  
Jennifer M. Stephens ◽  
Sarah Y. Liou ◽  
Kimbach T. Tran ◽  
Marc F. Botteman
Keyword(s):  
Adverse Events ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Economic Burden ◽  
Burden Of Illness ◽  
Consumer Price Index ◽  
Hematologic Malignancies ◽  
Outpatient Services ◽  
Cost Drivers ◽  
The Cost

Abstract OBJECTIVES: Hematologic adverse events such as neutropenia, thrombocytopenia, and anemia are commonly experienced by cancer patients receiving chemotherapy. These cytopenias are associated with increased morbidity and mortality, high healthcare costs, and decreases in quality of life. The objective of this study was to review the economic burden of these hematologic adverse events associated with chemotherapy in cancer patients. METHODS: A systematic search of the English-language medical literature published between 1990 and 2006 was conducted. Online conference proceedings and a review of article bibliographies were included in the review. Articles selected included prospective or retrospective studies specifically designed to examine burden of illness, direct medical costs, indirect costs, or cost drivers associated with neutropenia, thrombocytopenia, and anemia in adult cancer patients treated with chemotherapy. All original costs were reported, with adjusted figures (to 2006 US dollars) presented in parentheses using the medical care component of the consumer price index from the US Bureau of Labor Statistics. RESULTS: Of 160 studies initially identified, 64 met selection criteria and were reviewed in detail. The cost of neutropenia ranged from $1,893 (2006 US $2,632) per episode in the outpatient setting to $38,583 ($54,807) for a febrile neutropenia hospitalization. The cost of treating thrombocytopenia ranged from $1,037 ($1,395) to $7,550 ($9,336) per cycle or episode. Costs attributable to treating anemia ranged from $18,418 ($22,775) to $69,478 ($93,454) per year. Key cost drivers include hospitalization, drugs (e.g., granulocyte colony-stimulating factors and antibiotics), and diagnostic tests for neutropenia; hospitalization, major bleeding episodes, and platelet transfusions for thrombocytopenia; and inpatient and outpatient services, erythropoietic agents, and red blood cell transfusions for anemia. Another finding was that the costs of hematologic adverse events for patients with hematologic malignancies were up to twice that of patients with solid tumors. CONCLUSIONS: Chemotherapy-related cytopenias result in a substantial economic burden on patients, payers, caregivers, and society in general. This burden is particularly high for patients with hematologic malignancies due to the underlying malignancy. Furthermore, AEs affect the ability to deliver planned treatments, resulting in potentially suboptimal clinical outcomes. An evaluation of both clinical outcomes of chemotherapy and economic consequences as a result of chemotherapy-induced toxicities is recommended in determining optimal treatments for patients with cancer.

Impact of Chemotherapy-Induced Anemia on Economic and Quality of Life Outcomes in Adults with Cancer.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3355-3355 ◽  
Author(s):  
Kimbach T. Tran ◽  
Jennifer M. Stephens ◽  
Sarah Y. Liou ◽  
Marc F. Botteman
Keyword(s):  
Quality Of Life ◽  
Cancer Patients ◽  
Solid Tumors ◽  
Indirect Costs ◽  
Hematologic Malignancies ◽  
Life Outcomes ◽  
Cost Drivers ◽  
Quality Of Life Outcomes ◽  
The Cost

Abstract OBJECTIVES: Anemia is one of the most common hematologic adverse events experienced by cancer patients. The incidence of chemotherapy-induced anemia is as high as 100% for Grade 1 to 2 and 80% for Grade 3 to 4 anemia, although it varies depending on the cancer type and treatment regimen administered. Anemia is associated with high healthcare costs as well as decreased quality of life. The objective of this study was to review the economic and quality of life (QoL) outcomes of anemia in cancer patients. METHODS: A systematic search of the English-language literature published between 1990 and 2006 was conducted. Additional publications and conference proceedings were retrieved from the article bibliographies and included in the review. Articles selected include prospective or retrospective studies specifically designed to examine burden of illness, direct medical costs, indirect costs, cost drivers, or quality of life outcomes associated with chemotherapy-induced anemia in adult cancer patients. All original costs were reported, with adjusted figures (to 2006 dollars) presented in parentheses using the medical care component of the consumer price index from the US Bureau of Labor Statistics. RESULTS: Of 183 abstracts screened, 36 met selection criteria and were reviewed in detail. Fifteen and 11 studies focused on economics and QoL burden associated with anemia, respectively. The average annual cost attributable to anemia ranges from $18,418 (2006 US$ $22,775) to $69,478 ($93,454) per patient. Inpatient and outpatient services account for a significant portion of the total costs of anemia. Other key cost drivers for anemia include the cost of erythropoietic drugs, which range from approximately $210 ($239) to $1,090 ($1,288) per week, and the cost of red blood cell (RBC) transfusions, which range from $232 ($323) to $512 ($712) per unit. Patients with hematologic malignancies require almost double the number of RBC units and have higher associated costs than patients with solid tumors. Indirect costs include lost work time due to fatigue for an average of 4.2 sick/vacation days per month. In addition to raising the cost of care, anemia affects patient QoL in the following key domains: energy/fatigue, role (ability to work), social function, and leisure activities. Furthermore, some patients may report daily fatigue, overall decreasing everyday QoL. CONCLUSIONS: Anemia is a common hematologic adverse event experienced by cancer patients, resulting in significant health care costs, indirect costs, and decrements in patient QoL. In particular, patients with hematologic malignancies incur higher anemia-associated costs compared to patients with solid tumors. The economic burden of cancer treatment-induced anemia, as well as the impact on patient QoL, should be considered when making clinical decisions regarding the optimal treatment course for patients with cancer.

scholarly journals Severe neutropenia is associated with better clinical outcomes in patients with advanced pancreatic cancer who received modified FOLFIRINOX therapy

2018 ◽  
Author(s):  
Yunami Yamada ◽  
Hironori Fujii ◽  
Daichi Watanabe ◽  
Hiroko Kato-Hayashi ◽  
Koichi Ohata ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Adverse Events ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Advanced Pancreatic Cancer ◽  
Significant Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Incidence Rates ◽  
Severe Neutropenia ◽  
High Level

Modified FOLFIRINOX is effective for advanced pancreatic cancer but frequently causes severe neutropenia. The present study was designed to investigate the influence of severe neutropenia on clinical outcomes in advanced pancreatic cancer patients receiving modified FOLFIRINOX. Fifty-one advanced pancreatic cancer patients who received modified FOLFIRINOX during January 2014 and May 2018 were subjects of the present study. Adverse events, including neutropenia, were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. Median overall survival (OS) was determined as the primary endpoint, while median time to treatment failure (TTF), overall response rate (ORR), and the incidence of other adverse events were measured as secondary endpoints. Severe neutropenia (grade≥3) occurred in 39 patients (76.4%), in which high level of total bilirubin (>0.6mg/dL) was a significant risk as assessed by a multivariate logistic regression analysis. Median duration of OS was significantly longer in patients with severe neutropenia than in those without it (15.2 months versus 7.2 months, P=0.032). Moreover, there was a significant correlation between OS and the grade of neutropenia (R=0.306, P=0.029). ORR tended to be higher, though not significantly, in patients with severe neutropenia. In contrast, the incidence rates of other adverse events were not different between the two groups. Severe neutropenia is an independent predictor of prognosis in advanced pancreatic cancer patients received modified FOLFIRNOX therapy.

scholarly journals Costing analysis of outpatient services for major external structural birth defects: An ingredient approach in selected hospitals in Kiambu County, Kenya

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 359
Author(s):  
George Agot ◽  
Joseph Wang'ombe ◽  
Marshal Mweu
Keyword(s):  
Birth Defects ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Economic Burden ◽  
Care Providers ◽  
Outpatient Services ◽  
Pes Planus ◽  
Cost Drivers ◽  
Talipes Equinovarus ◽  
Costing Analysis

Background: Major external structural birth defects are known to exert an enormous economic burden on individuals and health services; however, they have been vastly unappreciated and underprioritized as a public health problem in settings where costing analyses are limited. Objective: The objective of this study was to conduct a costing analysis of outpatient services for major external structural birth defects in selected hospitals in Kiambu County, Kenya. Methods: A hospital-based cross-sectional study design was adopted in four hospitals where an ingredient approach was used to retrospectively gather data on cost drivers for interventions consisting of  castings, bracings, and tendonectomies for the under-fives from health care providers’ perspectives for a one-year time horizon (January 1st, 2018, to December 31st, 2018). The hospitals were selected for providing outpatient corrective and rehabilitative services to the under-fives. Prevalence-based morbidity data were extracted from outpatient occupational therapy clinic registers, whereas staff-time for the hospitals’ executives comprising the medical superintendents, chief nursing officers, orthopedic surgeons, and health administrative officers were gathered through face-to-face enquires from the occupational therapists being the closest proxies for the officers. Following a predefined inclusion criterion, 349 cases were determined, and associated cost drivers identified, measured, and valued (quantified) using prevailing market prices. The costs were categorized as recurrent, and unit economic costs calculated as average costs, expressed in U.S Dollars, and inflated to the U.S Dollar Consumer Price Index from January 2018 to December 2018. Results: The unit economic cost of all the cases was estimated at $1,139.73; and $1,143.51 for neural tube defects, $1,143.05 for congenital talipes equinovarus, and $1,109.81 for congenital pes planus. Conclusions: The highest economic burden of major external structural birth defects in the county was associated with neural tube defects, followed by congenital pes planus despite having the fewest caseloads.

Evaluating uptake and patient satisfaction with an out-of-pocket cost tracker for gynecologic cancer patients undergoing treatment.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 101-101
Author(s):  
Margaret Liang ◽  
Sarah S. Summerlin ◽  
Teresa KL Boitano ◽  
Christina T. Blanchard ◽  
Smita Bhatia ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Financial Distress ◽  
Financial Burden ◽  
Tertiary Care ◽  
Gynecologic Cancer ◽  
Medical Costs ◽  
Cancer Center ◽  
Outpatient Services ◽  
Patient Reported ◽  
The Cost

101 Background: Tracking expenses may be useful to minimize financial distress in cancer patients. Our objective was to evaluate uptake and satisfaction with an out of pocket (OOP) cost tracker for gynecologic cancer patients on treatment. Methods: Within a longitudinal survey to assess financial burden among gynecologic cancer patients starting a new line of systemic therapy at a tertiary-care cancer center, we provided worksheets for participants to track their OOP expenses voluntarily. We assessed patient usage and satisfaction at 3 and 6 months. Financial distress was measured using Comprehensive Score for Financial Toxicity < 26. Results: Among 121 participants with an average age of 59 years, 34 (28%) were African-American and 33 (27%) had a high school diploma or less. Half (55/110, 50%) of participants reported annual income < $40,000. Most participants had health insurance (113/121, 93%) and were unemployed (77/118, 65%). Forty-nine of 121 (40%) participants reported ever using the OOP cost tracker at 3 or 6 months. Those who used the cost tracker stated it was helpful to track costs (86%, 73%), easy to use (97%, 100%), and useful for budgeting (42%, 24%) at 3 and 6 months. Participants reported using the cost tracker at least weekly (33%, 19%), every 2 weeks (36%, 27%), or monthly (31%, 54%) at 3 and 6 months. Twelve participants returned their OOP cost trackers for review with a median use of 5.5 months (range 3-10). Average monthly patient-reported OOP costs (range) were: $41 ($0-$584) for direct non-medical costs (i.e., transportation, lodging), $15 ($0-$120) for outpatient services, $13 ($0-$150) for medications/supplies, and $9 ($0-$100) for hospital services. Use of the OOP cost tracker at 3 months was not associated with financial distress at baseline (p = 0.30) or at 3 months (p = 0.89). Qualitative analysis showed the OOP cost tracker reminded patients to save receipts and to track categories of cost they would not have otherwise considered. Conclusions: 40% of gynecologic cancer patients undergoing treatment used an OOP cost tracker worksheet and found it helpful and easy to use. Direct non-medical costs accounted for the highest average monthly patient-reported OOP cost.

scholarly journals Thrombocytopenia Among Patients with Hematologic Malignancies and Solid Tumors: Risk and Prognosis

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3156-3156
Author(s):  
Kasper Adelborg ◽  
Katalin Veres ◽  
Erzsébet Horváth-Puhó ◽  
Mary Clouser ◽  
Hossam A Saad ◽  
...  
Keyword(s):  
Platelet Count ◽  
Cancer Patients ◽  
Solid Tumors ◽  
Clinical Outcomes ◽  
Cancer Diagnosis ◽  
Hematologic Malignancies ◽  
Severe Thrombocytopenia ◽  
Cancer Type ◽  
Risk Of Death ◽  
Study Inclusion

Abstract Introduction: Despite the large body of research in cancer and increasing numbers of cancer survivors, knowledge about the risks and prognoses related to thrombocytopenia in the clinical care setting is scarce. Such information is important to understanding the need and potential impact of platelet transfusion and emerging drug therapies for thrombocytopenia. In this study, we examined the risk of thrombocytopenia among patients with incident cancer. Further, we studied the extent to which thrombocytopenia was associated with adverse clinical outcomes. Methods: This population-based cohort study was conducted using data from the Danish Cancer Registry. All patients diagnosed with incident hematologic malignancies and solid tumors (age of ≥18 years) during 2015─2018 were identified. Data were linked with routine laboratory test results from the primary care and hospital settings, as recorded in the Danish Register of Laboratory Results for Research. Based on platelet count levels (x 10 9/L), thrombocytopenia was categorized as grade 0 (any count)&lt;150; grade 1:&lt;100; grade 2:&lt;75; grade 3:&lt;50; and grade 4: &lt;25. We tabulated the prevalence of thrombocytopenia at study inclusion and calculated the cumulative incidence proportion (risk) of thrombocytopenia, accounting for the competing risk of death. Each patient with thrombocytopenia was matched up to 5 cancer patients without thrombocytopenia by age, sex, cancer type, cancer stage, and time from cancer diagnosis and index date. Cox proportional hazards regression analysis was used to compute hazard ratios (HRs) with 95% confidence intervals (CIs) of adverse clinical outcomes, including any bleeding leading to hospitalization, site-specific bleeding leading to hospitalization, transfusion (red blood cell, platelet, or fresh frozen plasma), and death. HRs were adjusted for Charlson Comorbidity Index scores and matching factors by design. Results: The analytic cohort comprised 11,785 patients with hematologic malignancies and 57,600 patients with solid tumors (median age=70 years). Any thrombocytopenia was observed during the 6 months preceding study inclusion among 18% of patients with hematologic malignancies (grades 1-2: 6% and grades 3-4: 5%) and 4% of patients with solid tumors (grades 1-2: 1% and grades 3-4: 0%). The 1-year and 4-year risks of new-onset thrombocytopenia were 30% and 40% for hematologic malignancies and 21% and 28% for solid tumors, respectively (Figure 1). Among patients who initiated chemotherapy following their cancer diagnosis (n=33,165), the 1-year and 4-year risks of thrombocytopenia were 50% and 62% for hematologic malignancies and 39% and 49% for solid tumors, respectively (Figure 2). Patients with grade 4 thrombocytopenia had higher rates of any bleeding leading to hospitalization than patients without thrombocytopenia [hematologic malignancies: HR=2.31 (95% CI: 1.43-3.73) and solid tumors: HR=4.52 (95% CI: 2.00-10.24)], while grades 1-3 thrombocytopenia did not confer a significantly increased rate of hospitalization for bleeding (Table 1). All grades of thrombocytopenia were associated with an increased rate of transfusion [overall for hematologic malignancies: HR=2.06 (95% CI: 1.91-2.23), and overall for solid tumors: HR=2.13 (95% CI: 1.83-2.48)] and with death [overall for hematologic malignancies: HR=2.01 (95% CI: 1.84-2.20), and overall for solid tumors: HR=1.44 (95% CI: 1.39-1.49)]. These associations increased in magnitude with decreasing platelet count levels. Conclusions: The risk of thrombocytopenia was substantial following a diagnosis of incident hematologic malignancy and solid tumors, with higher risks among patients who initiated chemotherapy. While only severe thrombocytopenia was a predictor of any hospitalization for bleeding, all grades of thrombocytopenia were associated with increased rates of transfusion and death. Our findings support the need for regular assessment of platelet count levels to identify cancer patients at risk of serious clinical outcomes. Figure 1 Figure 1. Disclosures Clouser: Amgen: Current Employment, Other: This work is related to Chemotherapy Induced Thrombocytopenia as a disease state, in this essence it is not directly related to an Amgen product; CIT is an area of scientific interest to Amgen with Romiplostim under development for this potential indicati. Saad: Amgen: Current Employment, Current equity holder in publicly-traded company.

A Review of the Economic Burden of Pleural and Pericardial Effusions in Cancer Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5514-5514
Author(s):  
Sarah Y. Liou ◽  
Jennifer M. Stephens ◽  
Kimbach T. Tran ◽  
Marc F. Botteman
Keyword(s):  
Pleural Effusion ◽  
Cancer Patients ◽  
Operating Room ◽  
Economic Burden ◽  
Medical Costs ◽  
Cost Of Care ◽  
Pleural Effusions ◽  
Cost Drivers ◽  
Direct Medical Costs ◽  
Pericardial Effusions

Abstract OBJECTIVES: Pleural and pericardial effusions can lead to severe outcomes. Cancer accounts for an estimated 40% of all pleural effusions. About half of the effusions diagnosed in cancer patients are malignant, while the rest are nonmalignant and may occur as complications of the cancer treatments themselves. Pleural and pericardial effusions are associated with increased morbidity and mortality as well as high healthcare costs. The objective of this study was to review the economic burden of pleural and pericardial effusions in cancer patients. METHODS: A systematic search of the English-language medical literature published between 1990 and 2006 was conducted. Additional publications and conference proceedings were retrieved from the article bibliographies and included in the review. Articles selected include prospective or retrospective studies specifically designed to examine burden of illness, direct medical costs, indirect costs, or cost drivers associated with pleural or pericardial effusions in cancer patients. All original costs were reported, with adjusted figures (to 2006 US dollars) presented in parentheses using the medical care component of the consumer price index from the US Bureau of Labor Statistics. RESULTS: Of 15 studies identified, 11 met selection criteria and were reviewed in detail. Seven references reported data on costs associated with pleural or pericardial effusions in cancer patients. The cost per episode of pleural effusion ranged from $3,391 (2006 US $4,387) for outpatient treatment with pleural catheter to $20,996 ($37,341) for talc pleurodesis. The most common treatment for malignant pleural effusion is chest tube insertion and drainage with instillation of a sclerosing agent. Key cost drivers for significant pleural effusions included operating room costs, surgeon fees, and drugs such as sclerosing agents. Resources used for management of low grade pleural effusions include chest x-rays, physician outpatient visits, diuretics, and corticosteroids. For the treatment of pericardial effusion, the costs of performing pericardiocentesis and a pericardial window procedure were estimated to be $4,446 and $14,641 (2006 US$), respectively. Cost components for pericardial effusions, depending on treatment modality selected, included echocardiogram (3–10%), intensive care unit (17–56%), sclerosant (1–4%), surgeon fees (28–29%), anesthesia fees (20%), and operating room costs (31%). CONCLUSIONS: Pleural and pericardial effusions lead to significant direct medical costs, contributing to the total cost of care among patients treated for cancer. These costs should be included in the economic evaluation of therapies that increase the risk of pleural and pericardial effusions. Given the scarcity of published analyses in this area, additional research is warranted to better understand the burden of pleural and pericardial effusions.

scholarly journals Economic Burden of Venous Thromboembolism in Cancer Patients — a Comparative Analysis between Matched Patients with Cancer with and without a Diagnosis of Venous Thromboembolism

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 366-366 ◽  
Author(s):  
Surbhi Shah ◽  
Nathan Rubin ◽  
Alok A. Khorana
Keyword(s):  
Cancer Patients ◽  
Economic Burden ◽  
Drug Costs ◽  
Cost Difference ◽  
Total Cost ◽  
Patients With Cancer ◽  
Median Total Cost ◽  
Number Of Visits ◽  
The Cost ◽  
Active Cancer

Abstract Background:Venous thromboembolism (VTE) is a major health problem occurring at a rate of 1/1000 adults in general population. Cancer patients have a much higher risk of VTE with an annual rate of 24.6/1000 patients and this contributes to significant morbidity and mortality in this patient population. The body of evidence related to the economic burden for VTE in cancer patients is limited to small institutional studies. With increasing burden of cost for cancer care there is a significant push for cost containment measures, physicians taking care of these patients should be more aware of the economic outcomes of their patient cares. Methods: We used a large claims based data set US database MarketScan (Truven Health Analytics) to explore the economic burden of VTE in cancer patients. Between January 1, 2013 and September 30, 2015 we identified 614,577 patients with cancer of these 195,290 were deemed to have active cancer out of which 6,569 had a VTE code in their medical claims. This study was conducted to assess the economic burden of VTE in cancer patients in comparison their non-VTE peers with similar cancer type. All-cause costs over 3-year period were used and included the costs of all services. These were further explored to compare the total cost of care, cost based on the site of utilization of care and pharmacy cost between the patients with VTE with their matched peers. VTE-related costs were identified with a primary or secondary diagnosis of DVT or PE, and were evaluated for the entire follow-up period, starting from the initiation of the anticoagulant therapy until end of eligibility or end of data, whichever was earlier. Continuous factors were summarized by the median. Wilcoxon signed-rank tests were used to test for differences in the distribution between the VTE and non-VTE groups for cost and number of visits. Overall costs as well as total cost per day/visit were compared between groups. The costs were also evaluated by site of utilization (Emergency room vs inpatient vs outpatient) and by cancer subtype. Results: Among active cancer enrollees, there were 6,569 (3.4%) enrollees with VTE and 188,721 (96.6%) without. Average age was around 60 years in both groups. There were approximately 50 % females in each group and breast cancer was the most common type of cancer in the non-VTE group while gastrointestinal cancers were more common in the VTE group. Incidence of comorbid conditions like diabetes, hypertension and chronic kidney disease was similar in both cohorts but chronic liver disease was found more often in the VTE cohort. The median total cost over the study period for the VTE group ($136,976) was 2.0 times that of the non-VTE group ($67,115). This pattern holds for the inpatient, emergency, and outpatient costs. Total median drug costs were about 4 times that of the VTE group ($10,457) than the non-VTE group ($2,621). The difference the cost between groups for these measures were all highly statistically significant (<0.001). However, the VTE group also had 1.7 times the median number of days/visits than the non-VTE group (p < 0.001 for all categories). After adjusting for the number of days, the median total cost per visit was still statistically significant (p<0.001); however the cost difference is much smaller ($1,132 in VTE vs. $984 in non-VTE,). The overall total cost in the VTE groups ranges from 1.3 (pancreatic) to 3.4 (other cancers) times that of the non-VTE patients for the various cancer types, all were statistically significant (p<0.001). After adjusting for the number of visits, the relative cost difference decreased for all cancer groups it ranges from 0.97 (gynecological) to 1.5 (other cancer) times that of the non-VTE patients for the various cancer groups. Lung, breast, gastrointestinal, and other types were statistically significant (p < 0.01). Discussion: Based on the real world information from a large insurance claims database, this study quantifies the incremental health care cost burden associated with VTE in cancer patients. It is clear from this study the patients with cancer and VTE seek medical care more frequently than their non-VTE counterparts leading to higher healthcare costs in all settings. It was also interesting to note that when only the drug costs were taken into consideration, enrollees with VTE had up to 4 times higher drug costs, not all of which was attributable to the anticoagulant cost. Disclosures Khorana: Bayer: Consultancy; Sanofi: Consultancy; Pfizer: Consultancy; Janssen: Consultancy.

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