The cost of treating pancreatic cancer: A pilot study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16004-16004
Author(s):  
A. R. Ogdie ◽  
B. C. Lee ◽  
J. Li ◽  
D. Maglaris ◽  
A. Siddiqi ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pilot Study ◽  
Standard Treatment ◽  
Indirect Costs ◽  
Duration Of Treatment ◽  
Anti Cancer ◽  
The Cost ◽  
Mean Time ◽  
Clinic Visits

16004 Background: The treatment of pancreatic cancer (PC) is rapidly changing with the approval of new anti-cancer agents. A pilot analysis of twenty five patients treated for PC was performed to determine the cost of PC treatment. Methods: Twenty-five PC patients were selected from 1998–2004 to represent a variety of treatments, both standard and experimental. Charts were reviewed for hospitalizations, clinic visits, and medications greater than $10 in cost. Costs were determined using pharmacy and hospital billing services. Average costs per month were calculated for all 25 patients in the twelve months preceding death. Results: Mean time from diagnosis to death was 13.6 months and mean duration of treatment was 12.6 months. During the period of treatment, mean monthly anti-cancer treatment and additional pharmacotherapy costs were $3,771 and $3,196 respectively. Mean monthly cost of hospitalizations and clinic visits were $2,258 and $213. In the last twelve months of life, months -3, -5, and -2 (death = 0) were most expensive with average spending of $65,557, $58,820, $47,727 respectively. Breakdown of costs in the three most expensive months was: anti-cancer agents (82%), hospitalization (15%), additional pharmacotherapy (3.0%), and clinic visits (0.5%). Conclusions: In this pilot study, we compiled major contributors to the cost of treating PC and then focused on the twelve months preceding death. Anti-cancer agents were determined to be the largest expenditure overall, and were a greater proportion of the cost in the most expensive months before death. This remains an underestimate as surgery, radiation, and indirect costs are not included. As newer agents become incorporated into standard treatment for PC, costs are expected to rise further. This data is being used in designing a larger study comparing costs, quality of life, and survival using newer combination chemotherapy. No significant financial relationships to disclose.

Debits and Credits in the Management of Depression

1993 ◽  
Vol 163 (S20) ◽  
pp. 33-39 ◽  
Author(s):  
John A. Henry
Keyword(s):  
Antidepressant Drugs ◽  
Indirect Costs ◽  
Depressive Illness ◽  
Cost Of Health Care ◽  
Outcome Differences ◽  
Cost Of Drugs ◽  
The Cost ◽  
Toxic Drugs ◽  
Financial Analyses

Concern over the cost of health care is playing an increasing role in Great Britain, but evaluation of benefit is generally inadequate. This is particularly true in the case of depression, for which the cost of drugs is 1.9% of the National Health Service pharmaceutical budget. Since differences in effectiveness between antidepressant drugs are difficult to demonstrate, quality-of-life studies may help to identify outcome differences. At present, the worst outcome of depressive illness - suicide - absolves carers from further costs. An assessment is needed which takes into account both the direct and indirect costs of depression; this should include the costs of investment into improving diagnosis. Even without financial analyses, it is clear that some cases of suicide can be prevented by prescribing less toxic drugs, but research is needed to investigate whether use of these drugs also reduces the costs of overdose.

scholarly journals Value-Based Healthcare in Ostomies

2020 ◽  
Vol 17 (16) ◽  
pp. 5879
Author(s):  
Ana C. Montesinos Gálvez ◽  
Francisco Jódar Sánchez ◽  
Carmen Alcántara Moreno ◽  
Antonio J. Pérez Fernández ◽  
Rosario Benítez García ◽  
...  
Keyword(s):  
Organizational Innovation ◽  
Indirect Costs ◽  
Quality Adjusted Life Year ◽  
Quality Cost ◽  
Iron Triangle ◽  
Related Quality ◽  
Health Related ◽  
The Cost ◽  
Delivery Models

In order to achieve significant improvements in quality, cost, and accessibility (the health “iron triangle”), innovation in organizational and service delivery models is necessary to increase the value of healthcare. The aim of this study is to evaluate the efficiency of a model of organizational innovation based on advanced practice nurse in the care of people with ostomies (APN-O) versus usual care. An observational, exploratory, analytical, prospective study with a six-month follow-up was carried out at 12 hospitals that implemented this model in Andalusia. A total of 75 patients who had undergone a digestive elimination ostomy and/or a urinary ostomy were followed for six months. Clinical outcomes, healthcare resources, health-related quality of life, and willingness to pay (WTP) were analyzed. The economic evaluation was conducted from a societal perspective, including healthcare costs and indirect costs. The cost difference between the two models was €136.99 and the quality-adjusted life year (QALY) gained was 0.05965 (€2297 per QALY gained). At six months, the mean of WTP was €69 per APN-O consultation. This model contributes to increasing the value-based healthcare in ostomies. Results of this study suggested that APN-O is an effective patient management model for improving their health status and is highly efficient.

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.

Cost of depression: effect of adherence and treatment response

2006 ◽  
Vol 21 (6) ◽  
pp. 349-354 ◽  
Author(s):  
L. von Knorring ◽  
A.-C. Åkerblad ◽  
F. Bengtsson ◽  
Å. Carlsson ◽  
L. Ekselius
Keyword(s):  
Quality Of Life ◽  
Major Depression ◽  
Treatment Response ◽  
Controlled Trial ◽  
Indirect Costs ◽  
The Mean ◽  
Cost Of Drugs ◽  
The Cost ◽  
The Impact

AbstractObjectives:The purpose of the present study has been to assess the societal cost of major depression and the distribution into different cost components. The impact of adherence and treatment response was also explored.Method:Data were collected from a randomized controlled trial of patients with major depressive disorder who were treated in a naturalistic primary care setting. Resource use and quality of life were followed during the two-year trial.Results:The mean total cost per patient during two years was KSEK 363 (EUR 38 953). Indirect costs were the most important component (87%), whereas the cost of drugs was minor (4.5%). No significant differences in costs or quality of life between treatment arms or between adherent and non-adherent patients were demonstrated. However, treatment responders had 39% lower total costs per patient and experienced a larger increase in quality of life compared to non-responders.Conclusions:Major depression has high costs for society, primarily due to indirect costs. Treatment responders have considerably lower costs per patient and higher quality of life than non-responders. This indicates that measures to increase response rates are also important from an economic perspective.

scholarly journals Calculating the economic burden of presumed microbial keratitis admissions at a tertiary referral centre in the UK

Eye ◽  
2020 ◽  
Author(s):  
George Moussa ◽  
James Hodson ◽  
Nick Gooch ◽  
Jasvir Virdee ◽  
Cristina Penaloza ◽  
...  
Keyword(s):  
Data Collection ◽  
Indirect Costs ◽  
Emergency Admission ◽  
Epidemiological Data ◽  
Microbial Keratitis ◽  
Tertiary Referral Centre ◽  
Costs Of Disease ◽  
The Uk ◽  
The Cost

Abstract Purpose Microbial keratitis (MK) is the most common non-surgical ophthalmic emergency admission in the UK. However, few prospective health-economic studies of MK have been performed, and no specific healthcare resources group (HRG) code exists. This study is designed to determine the feasibility of a data collection tool derived from the microbiology ophthalmology group (MOG) clinical record form, to enable quantification of direct costs of inpatient care, as well as prospective capture of epidemiological data relating to outcomes of MK. Methods Clinical, demographic and economic data were collected retrospectively between January and December 2013 for 101 consecutive patients admitted with MK, using an adaption of the MOG toolset. The direct cost of admission (COA) was calculated using national reference costs and compared to actual income to generate profit/deficit profiles for individual patients. Indices of multiple deprivation were used to assess effect of deprivation on the COA. Results The total income generated through discharge coding was £252,116, compared to a COA of £357,075, yielding a deficit of £104,960 (median: £754 per patient). The cost deficit increased significantly with length of stay (LOS, p < 0.001), whilst patients with short LOS were income generators; cost neutrality occurred at 4.8 days. Greater socioeconomic deprivation was also associated with a significantly higher cost deficit. Conclusion LOS is the key driver for COA of care for MK admissions. Protocols should encourage discharge of patients who are able to self-administer treatment after the sterilisation phase. The MOG-derived data collection toolset captures pertinent clinical data for quantification of COA. Further development into a multiuser and multisite platform is required for robust prospective testing, together with expansion to capture indirect costs of disease burden, including impact of treatment, visual morbidity and quality of life.

scholarly journals The effectiveness of pancreatic enzyme replacement therapy for malabsorption in advanced pancreatic cancer, a pilot study

2019 ◽  
Vol 12 ◽  
pp. 117822421882527 ◽  
Author(s):  
Amanda Landers ◽  
Helen Brown ◽  
Matthew Strother
Keyword(s):  
Quality Of Life ◽  
Pancreatic Cancer ◽  
Pilot Study ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Enzyme ◽  
Advanced Pancreatic Cancer ◽  
Enzyme Replacement ◽  
Pancreatic Enzyme Replacement Therapy

Advanced adenocarcinoma of the pancreas has a globally poor prognosis. One of the characteristic features of pancreatic cancer (PC) is pancreatic exocrine insufficiency (PEI). This leads to a malabsorption syndrome and subsequent digestive symptoms. Given the high prevalence of PEI and malabsorption in PC, empiric use of pancreatic enzyme replacement therapy (PERT) is recommended. The aim of this pilot study was to determine the potential efficacy of PERT in improving symptoms and quality of life in those with metastatic PC. The study recruited patients with advanced PC referred to a specialist palliative care service. Following an initial assessment, patients were commenced on pancrealipase 25,000IU (Creon) and reassessed after 1 week and 3 weeks post-initiation of supplementation. These assessments included demographics, malabsorption symptom checklist, and completion of two validated quality-of-life questionnaires, the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-PAN26. PERT was associated with statistically significant improvement of symptoms in both the general (QLQ-C30) and pancreatic cancer specific tool (PAN26). Within 1 week of PERT initiation, there was a reduction in diarrhoea scores (26 vs. 8, p<0.005), pancreatic and hepatic pain (47 vs. 33 and 24 vs. 11, respectively, p<0.05). After 3 weeks, there were significant improvements in pancreatic pain and bloating/gas symptoms (47 vs. 26 and 46 vs. 26, respectively, p< 0.005). PERT appears to have the potential to improve symptoms of malabsorption in patients with metastatic PC.

scholarly journals Efficacy of mistletoe extract as a complement to standard treatment in advanced pancreatic cancer: study protocol for a multicentre, parallel group, double-blind, randomised, placebo-controlled clinical trial (MISTRAL)

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathrin Wode ◽  
Johanna Hök Nordberg ◽  
Gunver S. Kienle ◽  
Nils O. Elander ◽  
Britt-Marie Bernhardson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pancreatic Cancer ◽  
Overall Survival ◽  
Standard Treatment ◽  
Advanced Pancreatic Cancer ◽  
Health Related Quality ◽  
Mistletoe Extract ◽  
Related Quality ◽  
Health Related

Abstract Background Most pancreatic cancer patients present with advanced stage at diagnosis with extremely short expected survival and few treatment options. A multimodal palliative approach is necessary for symptom relief and optimisation of health-related quality of life. In a recent open-label trial of mistletoe extract for advanced pancreatic cancer patients not eligible for chemotherapy, promising results on improved overall survival and better health-related quality of life were reported. The objective of the present study is to assess the value of mistletoe extract as a complement to standard treatment (palliative chemotherapy or best supportive care) in advanced pancreatic cancer patients with regard to overall survival and health-related quality of life. Methods The trial is prospective, randomised, double-blind, multicentre, parallel group and placebo-controlled. In total, 290 participants are randomly assigned to placebo or mistletoe extract given subcutaneously in increasing dosage from 0.01 to 20 mg three times per week for 9 months. Stratification is performed for site and palliative chemotherapy. Main inclusion criteria are advanced pancreatic cancer and Eastern Cooperative Oncology Group performance status 0 to 2; main exclusion criteria are life expectancy less than 4 weeks and neuroendocrine tumour of the pancreas. Two ancillary studies on sub-sets of participants are nested in the trial: a biomarker study collecting blood samples and a cross-sectional qualitative study with semi-structured face-to-face interviews. Discussion To our knowledge, this is the first placebo-controlled randomised trial assessing the impact of mistletoe extract as a complement to standard treatment on overall survival and health-related quality of life in patients with advanced pancreatic cancer. The presented trial with its two nested ancillary studies exploring biomarkers and patient experiences is expected to give new insights into the treatment of advanced pancreatic cancer. Trial registration EU Clinical Trial Register, EudraCT Number 2014-004552-64. Registered on 19 January 2016. ClinicalTrials.gov NCT02948309. Registered on 28 October 2016.

Using Patients As Their Own Controls for Cost Evaluation of Phase I Clinical Trials

2004 ◽  
Vol 22 (7) ◽  
pp. 1308-1314 ◽  
Author(s):  
Eric J. Sherman ◽  
David M. Rubin ◽  
Ennapadam Venkatraman ◽  
Gary K. Schwartz ◽  
Vincent A. Miller ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Pilot Study ◽  
Phase I ◽  
Linear Mixed Model ◽  
Standard Treatment ◽  
Cost Evaluation ◽  
Phase I Trials ◽  
Phase I Clinical Trials ◽  
Significant Difference ◽  
The Cost

PurposeLittle is known about the cost of phase I trials in cancer patients compared with that of standard treatments, yet the former is often assumed to be greater than the latter. Our objective was to utilize a new approach, using patients as their own controls, to compare in a pilot study the costs of care for patients on phase I trials with those incurred for standard treatment.Patients and MethodsWe retrospectively assessed the direct medical costs (DMCs) of 59 patients participating in one of two phase I trials (TRIAL) in solid tumors conducted at Memorial Hospital (MH): (1) perillyl alcohol, and (2) flavopiridol with paclitaxel. Paired-control DMCs were those accrued by the same patient while receiving standard chemotherapy regimens just before (PRE; n = 41) or after (POST; n = 29) the trial at MH, averaged per day.ResultsFor the 41 PRE patients, the median and mean DMCs per day for the clinical trial versus standard treatment were (US $) $123 v $133 and $219 v $267, respectively. For the 29 POST patients, the median and mean DMCs for the clinical trial versus standard treatment were $157 v $152 and $226 v $226, respectively. Using a linear mixed model, there was no significant difference between TRIAL and standard treatment DMCs (P = .54).ConclusionUsing patients as their own controls represents a new, efficient method for evaluating the cost of phase I trials, and it warrants further study. The results of our pilot study do not suggest that phase I trials always cost payers more than standard treatment.

Membrane bioreactor application in wastewater re-use from the effluent of Bali primary WWTP, northern Taiwan

2006 ◽  
Vol 53 (9) ◽  
pp. 131-140 ◽  
Author(s):  
H.H. Chen ◽  
S. Shiau ◽  
Y.C. Lin
Keyword(s):  
Pilot Study ◽  
Membrane Bioreactor ◽  
Reclaimed Water ◽  
Domestic Wastewater ◽  
Wastewater Reclamation ◽  
Industrial Parks ◽  
Taipei City ◽  
The Cost ◽  
Northern Taiwan

Two MBR pilot systems were constructed and tested in the Bali Primary WWTP. The pilot study shows that two MBR systems, i.e. the Green-MenBio system (MBR-1) and the Bio-MF system (MBR-2), can both fulfill the requirement of wastewater reclamation standard. The MBR-2 system is more economical compared with MBR-1 system. The cost of US$ 0.10–0.16/m3 is estimated to reclaim the effluent of primary WWTP in Taiwan. The Bali Primary WWTP has the capacity of 1,320,000 cmd which is the biggest in Taiwan. The domestic wastewater of partial Taipei City and Taipei County are collected and transported to the Bali Primary WWTP. The effluent of the Bali Primary WWTP is then discharged into the ocean through two 3.8 m marine outfalls. The AO processes are installed in both MBR systems. More than 90% of the NH3-N can be removed through the AO and membrane processes. The outflow of the MBR systems (without RO) can reach the quality of COD &lt;30 mg/l, BOD &lt;10 mg/l, SS &lt;5 mg/l, NH3-N &lt;3 mg/L. The outflow of the MBR system is proposed to transport 40 km south to the Taoyuan County where four new industrial parks are to be constructed. Part of the reclaimed water is to be used on irrigation and another portion is to be sent to the industries after RO treatment.

scholarly journals The cost–effectiveness of oral semaglutide versus empagliflozin in Type 2 diabetes in Denmark

2021 ◽  
Author(s):  
Lars H Ehlers ◽  
Mark Lamotte ◽  
Mafalda C Ramos ◽  
Susanne Sandgaard ◽  
Pia Holmgaard ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Duration Of Treatment ◽  
Diabetes Model ◽  
Life Years ◽  
The Cost

Aim: To evaluate the cost–effectiveness of oral semaglutide+metformin versus empagliflozin+metformin in people with Type 2 diabetes uncontrolled on msetformin alone. Materials and methods: The IQVIA Core Diabetes Model was populated with efficacy data from a head-to-head study between oral semaglutide+metformin and empagliflozin+metformin. Danish costs and quality-of-life data were sourced from literature. Price per day was Danish Krone (DKK) 25.53 for oral semaglutide and DKK11.40 for empagliflozin. Discounting was fixed at 4%. Scenario and sensitivity analyses were performed. Results: Over a lifetime, Core Diabetes Model projected 8.78 and 8.75 quality-adjusted life-years and a total cost of DKK 447,633 and DKK 387,786; thereby, generating an incremental cost–effectiveness ratio of DKK 1,930,548 for oral semaglutide+metformin versus empagliflozin+metformin. Scenario and sensitivity analyses showed the robustness of the outcomes. Duration of treatment with oral semaglutide is the key driver of the analyses. Conclusion: Oral semaglutide+metformin seems not cost-effective versus empagliflozin+metformin in patients uncontrolled on metformin in Denmark.

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