Cost of Outpatient Blood Transfusion in Cancer Patients

2000 ◽  
Vol 18 (14) ◽  
pp. 2755-2761 ◽  
Author(s):  
Pierre-Yves Crémieux ◽  
Barbara Barrett ◽  
Kenneth Anderson ◽  
Mitchell B. Slavin
Keyword(s):  
Cancer Patients ◽  
Solid Tumors ◽  
Average Cost ◽  
Flow Diagram ◽  
Fiscal Year ◽  
Cancer Center ◽  
Tumor Type ◽  
Substantial Impact ◽  
Pediatric Cancer Patients ◽  
The Cost

PURPOSE: To determine the cost of outpatient RBC transfusion from the provider’s perspective at a major urban, academic cancer center. PATIENTS AND METHODS: We retrospectively studied 517 cancer patients with hematologic or solid tumors who received blood during fiscal year 1995 to 1996. A process-flow diagram was developed, and cost and utilization data for 12 months were collected and analyzed. A structured interview process was used to identify all direct and indirect costs from within the inpatient unit, blood bank, and outpatient clinic. Average costs were computed for the entire sample and for specific subgroups. RESULTS: In 1998 dollars, the average cost per RBC unit was $469 for adults and $568 for pediatric cancer patients. Adults and children generally received two and one RBC units per transfusion, respectively. Therefore, the average cost of a two-unit transfusion was $938 for adults. Patients with hematologic tumors required more RBC units (7.1 RBC units per year) at a higher average cost ($512 per RBC unit) than patients with solid tumors (4.7 RBC units per year, $474 per RBC unit). Further variations across tumor types were observed. Overhead, direct material, and direct labor represented 46%, 19%, and 35% of total costs respectively. CONCLUSION: The cost of outpatient RBC transfusions in cancer patients is higher than previously reported, in part because overhead costs and fixed costs might have been underestimated in previous studies. Furthermore, age, tumor type, and geographic variations in the cost of fixed assets and labor have a substantial impact on the cost of blood. The results indicate that the cost-effectiveness of alternatives to transfusions in the management of cancer patients may have been underestimated in the existing literature.

scholarly journals Cost of Treating Pediatric Cancer at the Butaro Cancer Center of Excellence in Rwanda

2018 ◽  
pp. 1-7
Author(s):  
Claire Neal ◽  
Christian Rusangwa ◽  
Ryan Borg ◽  
Jean Claude Mugunga ◽  
Stephanie Kennell-Heiling ◽  
...  
Keyword(s):  
Social Support ◽  
Hodgkin Lymphoma ◽  
Survival Rates ◽  
Treatment Protocol ◽  
Fiscal Year ◽  
Cancer Center ◽  
Labor Costs ◽  
Center Of Excellence ◽  
The Cost

Purpose Improvements in childhood survival rates have been achieved in low- and middle- income countries that have made a commitment to improve access to cancer care. Accurate data on the costs of delivering cancer treatment in these settings will allow ministries of health and donors to accurately assess and plan for expansions of access to care. This study assessed the financial cost of treating two common pediatric cancers, nephroblastoma and Hodgkin lymphoma, at the Butaro Cancer Center of Excellence in rural Rwanda. Methods A microcosting approach was used to calculate the per-patient cost for Hodgkin lymphoma and nephroblastoma diagnosis and treatment. Costs were analyzed retrospectively from the provider perspective for the 2014 fiscal year. The cost per patient was determined using an idealized patient receiving a full course of treatment, follow-up, and recommended social support in accordance with the national treatment protocol for each cancer. Results The cost for a full course of treatment, follow-up, and social support was determined to be between $1,490 and $2,093 for a patient with nephroblastoma and between $1,140 and $1,793 for a pediatric patient with Hodgkin lymphoma. Conclusion Task shifting, reduced labor costs, and locally adapted protocols contributed to significantly lower costs than those seen in middle- or high-income countries.

HSR19-076: A Prospective Study of the Usage of Pain Medication, Cost, Alternative Medication Use, and Outcome by Cancer Patients in Real World

2019 ◽  
Vol 17 (3.5) ◽  
pp. HSR19-076
Author(s):  
Praveen Adusumilli ◽  
Vidya Viswanath ◽  
Raghunadha Rao Digumarthi
Keyword(s):  
Palliative Care ◽  
Side Effects ◽  
Cancer Patients ◽  
Average Cost ◽  
Pain Medication ◽  
Cancer Center ◽  
Medication Cost ◽  
Palliative Care Specialist ◽  
Care Specialist ◽  
A Prospective Study

Introduction: Perception of pain and the need to treat it is highly variable, even amongst oncologists. Availability of pain specialists is an added advantage. This is an analysis of prescription patterns of pain medication and its outcome in cancer patients. Materials and Methods: The center has 8 oncologists and a pain and palliative care specialist. All the patients presenting to the outpatient department of our institute with a diagnosis of cancer were prospectively analyzed for usage of pain medication using a structured questionnaire. Data on diagnosis, stage, treatment given, and outcomes were analyzed. Pain intensity was recorded on visual analogue scale, types of pain medicines used, and their side effects were noted. The average cost of the pain medication purchased in our pharmacy was calculated. Use of alternative medicines was also noted. Results: A total of 1,098 cancer patients were evaluated. Pain was a prominent complaint in 64.6% of patients. Of these, only 89.5% received pain medication. Mild, moderate, and severe pain was seen in 52.1%, 26.7%, and 21.2% respectively. The 3 most common diagnoses were breast cancer in 19.7%, gastrointestinal cancer in 14%, and 12.1% with head and neck cancers. Weak opioids and NSAIDS were most commonly prescribed analgesics in 44.2% and 42.1%, respectively. Morphine was prescribed for 13.7% of patients. The average cost of pain medicines is Re 148 (US $2.25 a month). Side effects from medication were seen in 13.5% of patients, with constipation being the most common. Alternative forms of medicine were reportedly used by 148 patients: Ayurveda by 20.8%, and homeopathy by 12.9%, native medication by 6.1%, Unani by 1.8%. Good relief of pain was reported by 66%, fair relief by 27%, no relief by 6.1%, and worsening by <1%. Conclusion: Pain management is near ideal with the availability of services of pain and palliative care specialist in a cancer center.

Use and Outcomes of Epoetin Alfa and Darbepoetin Alfa for Anemic Cancer Patients in Outpatient Community Practice Settings.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5588-5588 ◽  
Author(s):  
Kyle R. Fahrbach ◽  
Diana Frame ◽  
Brian Sercus ◽  
Brad Schenkel
Keyword(s):  
Cancer Patients ◽  
Darbepoetin Alfa ◽  
Selection Criteria ◽  
Tumor Type ◽  
Community Practice ◽  
Epoetin Alfa ◽  
Treatment Episode ◽  
End Of Treatment ◽  
Dosing Regimens ◽  
The Cost

Abstract Objective: To assess the treatment patterns and hematologic outcomes associated with epoetin alfa (EPO) and darbepoetin alfa (DARB) for the treatment of anemic cancer patients in the community practice setting. Methods: A retrospective observational study design was used. De-identified data from patients receiving care in community oncology practice settings were obtained from an electronic medical record system. Eligible patients were >= 18 years of age, had a cancer diagnosis, and were treated with an erythropoiesis stimulating agent (ESA: EPO or DARB) during the period July 2002 – July 2004, with baseline anemia (Hb<=11 g/dL) and at least one follow-up Hb value. No other selection criteria were applied (e.g. ESA dose, tumor type, chemotherapy treatment) in keeping with the objective of characterizing outcomes in a real-world setting. Data were summarized by treatment overall and by using a multivariate model adjusting for age, gender, baseline Hb, clinic site, ECOG performance score, type of cancer (solid vs hematologic) and chemotherapy (platinum vs non-platinum vs. none). Patient selection criteria and analytic methods were determined prospectively. The cost for each ESA was calculated based on 2004 average wholesale prices ($13.36 per EPO 1,000 U; $4.99 per 1 mcg DARB). Results: 2382 EPO and 1399 DARB patients were eligible for analysis. The two groups were comparable in terms of baseline characteristics (62% female, 75% solid tumors, mean baseline Hb 9.9 g/dL). Only about two-thirds of patients were treated with standard dosing regimens of the two agents in the US (EPO 40,000 U qw, DARB 200 mcg q2w). Hematologic outcomes observed in patients receiving EPO were consistently better than those in patients receiving DARB. Table 1. Hematologic outcomes by ESA treatment EPO DARB p value Week 4 Hb change (g/dL) 0.79 0.59 <0.001 % Early Hb response (Hb change >=1 g/dL at 4 weeks) 61.5 55.2 0.004 % Hb response (Hb change >=2 g/dL by end of treatment episode) 41.4 34.7 <0.001 % Hematopoietic response (Hb change >= 2 g/dL or reaching 12 g/dL by end of treatment episode) 52.3 44.6 <0.001 The mean treatment durations for patients receiving EPO and DARB were 55.3 and 62.5 days, respectively. Mean cumulative doses were 231,211 U for EPO and 857 mcg for DARB. These doses resulted in an average cost per patient of $3,089 for those receiving EPO and $4,276 for those receiving DARB. Conclusion: These results, based on over 3000 community-treated cancer patients, reinforce previous findings of earlier and greater overall hematologic response for EPO vs. DARB in this setting. Additionally, based on mean cumulative doses, the cost of DARB per patient was substantially greater than that of EPO. Additional studies of variations in dosing regimens used in the community setting are warranted, as are well-powered, randomized, controlled trials to further confirm the clinical results observed here.

Characteristics and outcomes of cancer patients ≥80 years treated with chemotherapy at a comprehensive cancer center

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8548-8548
Author(s):  
P. Jiang ◽  
M. Choi ◽  
D. Smith ◽  
L. Heilbrun ◽  
S. M. Gadgeel
Keyword(s):  
Cancer Patients ◽  
Solid Tumors ◽  
Solid Tumor ◽  
Hematologic Malignancy ◽  
Survival Rates ◽  
The United States ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Tumor Patients ◽  
Hematologic Cancer

8548 Background: The percentage of cancer patients ≥ 80 years old is expected to rise in the United States. However data are limited on use of chemotherapy in this group of patients. Methods: Retrospective identification of patients who received systemic chemotherapy at our cancer center between 1/1/2000 to 12/31/2004 was performed using the computer generated pharmacy data and medical records. Patients who had diagnosis of cancer and ≥ 80 years were included in the study; patients receiving only supportive care, hormonal therapy, or oral chemotherapy were excluded. The protocol for this study was approved by the Wayne State University IRB. Results: A total of 133 patients ≥ 80 years who received chemotherapy was analyzed. The median age was 83 and 31% of the patients were ≥ 85 years. There were more females (61%) than males (39%). The gender distribution was more even (47% v. 53%) after excluding gender specific tumors. The racial distribution was diverse- Whites 65 (49%); Blacks 41 (31%); Other 18 (13%); Unknown 9 (7%). 16% of the patients had hematologic malignancy and 84% had solid tumors. Gynecological cancers (32%) followed by aerodigestive cancers (26%) were the most common solid tumors. Solid tumor patients primarily had regional (48%) or distant (45%) disease. During the first regimen, 512 cycles of chemotherapy was delivered with a median of 3 cycles per patient (range 1–24 cycles); 40% of patients received only 2 cycles of chemotherapy. 64% of patients were able to receive chemotherapy without 2nd cycle delay. The distribution of single or multidrug regimens was fairly similar; Solid tumors 52% v. 48%; Hematologic cancers 43% v. 57%. Carboplatin and paclitaxel (22%) was the most common regimen among solid tumor patients. 26% of all patients received a second regimen. The 1 year survival rates among hematologic cancer and solid tumor patients were 65% and 48%, respectively. Stage of disease was the only statistically significant factor predicting survival. Conclusions: In this diverse group of cancer patients ≥ 80 years old and selected for chemotherapy, the treatment was feasible. The survival outcomes in this elderly population were comparable to those of a younger patient population suggesting that the treatment is beneficial. No significant financial relationships to disclose.

scholarly journals Estimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration

2021 ◽  
Vol 6 (2) ◽  
pp. 238146832110579
Author(s):  
Todd H. Wagner ◽  
Jeanie Lo ◽  
Erin Beilstein-Wedel ◽  
Megan E. Vanneman ◽  
Michael Shwartz ◽  
...  
Keyword(s):  
Average Cost ◽  
Surgical Care ◽  
Risk Scores ◽  
Fiscal Year ◽  
Veterans Health ◽  
Health Administration ◽  
Complex Patients ◽  
Risk Patients ◽  
Community Providers ◽  
The Cost

Background. Veterans’ access to Veterans Affairs (VA)-purchased community care expanded due to large increases in funding provided in the 2014 Veterans Choice Act. Objectives. To compare costs between VA-delivered care and VA payments for purchased care for two commonly performed surgeries: total knee arthroplasties (TKAs) and cataract surgeries. Research Design. Descriptive statistics and regressions examining costs in VA-delivered and VA-purchased care (fiscal year [FY] 2018 [October 2017 to September 2018]). Subjects. A total of 13,718 TKAs, of which 6,293 (46%) were performed in VA. A total of 91,659 cataract surgeries, of which 65,799 (72%) were performed in VA. Measures. Costs of VA-delivered care based on activity-based cost estimates; costs of VA-purchased care based on approved and paid claims. Results. Ninety-eight percent of VA-delivered TKAs occurred in inpatient hospitals, with an average cost of $28,969 (SD $10,778). The majority (86%) of VA-purchased TKAs were also performed at inpatient hospitals, with an average payment of $13,339 (SD $23,698). VA-delivered cataract surgeries were performed at hospitals as outpatient procedures, with an average cost of $4,301 (SD $2,835). VA-purchased cataract surgeries performed at hospitals averaged $1,585 (SD $629); those performed at ambulatory surgical centers cost an average of $1,346 (SD $463). We also found significantly higher Nosos risk scores for patients who used VA-delivered versus VA-purchased care. Conclusions. Costs of VA-delivered care were higher than payments for VA-purchased care, but this partly reflects legislative caps limiting VA payments to community providers to Medicare amounts. Higher patient risk scores in the VA could indicate that community providers are reluctant to accept high-risk patients because of Medicare reimbursements, or that VA providers prefer to keep the more complex patients in VA.

Immunologic Reactivity in Patients Bearing Solid Tumors

1980 ◽  
Vol 66 (3) ◽  
pp. 311-318 ◽  
Author(s):  
Emma Menconi ◽  
Anna Barzi ◽  
Massimo Greco
Keyword(s):  
Cancer Patients ◽  
Solid Tumors ◽  
Peripheral Lymphocyte ◽  
Immune Reactivity ◽  
Immune Competence ◽  
Tumor Type ◽  
Healthy Controls ◽  
In Vivo Tests

The immune reactivity of 50 patients with solid tumors before therapeutic treatment and 26 healthy controls was assessed by both in vitro and in vivo tests. No significant differences between controls and patients were found in peripheral lymphocyte counts or in delayed hypersensitivity to recall antigens. However, impairment of lymphocyte stimulation with phytohemagglutinin (PHA) and a decrease in the number of E-rosette forming cells (E-RFC) were detected in cancer-bearing patients irrespective of tumor type. The results of the present study further confirm the usefulness of the PHA and E-RFC tests in monitoring the immune competence of cancer patients.

Prospective agnostic germline testing in pediatric cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1589-1589
Author(s):  
Elise Fiala ◽  
Jennifer Kennedy ◽  
Yelena Kemel ◽  
Audrey Mauguen ◽  
Diana Mandelker ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Solid Tumors ◽  
Pediatric Cancer ◽  
Spinal Tumors ◽  
Cancer History ◽  
Pediatric Solid Tumors ◽  
Pediatric Cancer Patients ◽  
High Penetrance ◽  
Tumor Types ◽  
Dominant Genes

1589 Background: We report our large cohort of pediatric cancer patients undergoing prospective agnostic germline sequencing. Our dataset is a significant addition to the 1,573 children reported to date who have undergone agnostic germline sequencing in previous large sequencing studies, each with ascertainment bias. Methods: 676 patients with pediatric solid tumors underwent matched tumor-normal targeted DNA sequencing from July 2015 to February 2020. At least 76 genes associated with cancer predisposition were analyzed in the germline, and variants were classified per American College of Medical Genetics guidelines. Pathogenic and likely pathogenic (P/LP) variants were reported to patients/families, who were offered genetic counseling and cascade testing with screening recommendations and referral to a surveillance clinic as appropriate. Results: One or more P/LP variants were found in 17% (115/676) of individuals when including low, moderate and high penetrance mutations in recessive and dominant genes, or 12% (81/676) when including moderate and high penetrance mutations in dominant genes. P/LP variants were detected in 40% (21/53) of patients with retinoblastomas, 8% (13/161) with neuroblastomas/ganglioneuroblastomas, 13% (14/112) with brain/spinal tumors, 8% (20/245) with sarcomas, and 12% (13/105) with other solid tumors. The most frequent mutations were in RB1 (n = 28) and TP53 (n = 8) in patients with associated tumors. Of patients with moderate/high penetrance mutations, 30% (24/81) had unexpected tumor types, with potential therapeutic relevance in 58% (14/24) including BRCA1 n = 2, BRCA2 n = 3, RAD51D n = 1, ATM n = 1 MLH1 n = 1, MSH2 n = 1, MSH6 n = 1, PMS2 n = 3, and SUFU n = 1. Two patients received immunotherapy based on their germline finding. Conclusions: P/LP germline variants are frequently present in patients with pediatric cancer. We are contributing significantly to the cohort size of agnostic sequencing in pediatric cancers. Our experience is similar to other studies with a ~12% detection rate of moderate and high penetrance mutations. Moderate/high penetrance mutations were concordant with the patient’s cancer history in 70% of cases, higher than previously reported, likely due to an enrichment of retinoblastoma. While many mutations are identified in patients with associated tumor types, a large proportion of mutations are unexpected based on the patient’s history. Clinical actionability of these findings may include screening, risk reduction, family planning, and increasingly targeted therapies.

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.

Physical Activity in Pediatric Cancer patients with solid tumors (PAPEC): Trial rationale and design

2013 ◽  
Vol 36 (1) ◽  
pp. 106-115 ◽  
Author(s):  
Luisa Soares-Miranda ◽  
Carmen Fiuza-Luces ◽  
Alvaro Lassaletta ◽  
Elena Santana-Sosa ◽  
Julio R. Padilla ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cancer Patients ◽  
Solid Tumors ◽  
Pediatric Cancer ◽  
Pediatric Cancer Patients

scholarly journals Emergency room imaging in pediatric patients with cancer: analysis of the spectrum and frequency of imaging modalities and findings in a tertiary cancer center and their relationship with survival

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sungmin Woo ◽  
Abdallah Araji ◽  
Mohammad Ali El Amine ◽  
Natalie Gangai ◽  
Elizabeth Acquafredda ◽  
...  
Keyword(s):  
Emergency Room ◽  
Cancer Patients ◽  
Pediatric Cancer ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Inpatient Admission ◽  
Cancer Center ◽  
Pediatric Cancer Patients ◽  
Tertiary Cancer Center

Abstract Background To assess the spectrum and frequency of modalities used for emergency room (ER) imaging and their findings in pediatric cancer patients and assess their relationship with survival. Methods Consecutive pediatric cancer patients that underwent imaging during an ER visit at our tertiary cancer center over a 5-year period were retrospectively analyzed. Imaging findings were considered positive when they were relevant to the ER presenting complaint. Imaging positivity was correlated with inpatient admission. Overall survival (OS) was assessed with Kaplan-Meier curves and uni- and multi-variate Cox proportional hazards model was used to identify significant factors associated with OS. Results Two hundred sixty-one patients (135 males and 126 females; median age 11 years [interquartile range 5–16 years] with 348 visits and a total of 406 imaging studies were included. Common chief complaints were related to the chest (100 [28.7 %]) and fever (99 [28.4 %]). ER imaging was positive in 207 visits (59.5 %), commonly revealing increased metastases (50 [14.4 %]), pneumonia (47 [13.5 %]), and other lung problems (12 [2.9 %]). Positive ER imaging was associated with inpatient admission (69.3 % [133/192] vs. 40.4 % [63/156], p < 0.01). Multivariate survival analysis showed that positive ER imaging (hazard ratio [HR] = 2.35 [95% CI 1.44–3.83, p < 0.01), admission (HR = 1.86 [95% CI 1.17–3.00], p < 0.01), number of ER visits (HR = 3.08 [95% CI 1.62–5.83], p < 0.01 for ≥ 3 visits) were associated with poorer survival. Conclusions Imaging was able to delineate the cause for ER visits in children with cancer in over half of the cases. Positive ER imaging was associated with admission and worse survival.

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