Intrathecal drug delivery versus comprehensive medical management as it may impact inpatient length of stay, readmission, and inpatient cost of care

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18520-18520
Author(s):  
J. D. Isaacs ◽  
L. J. Stearns ◽  
W. H. Poling ◽  
D. Milton ◽  
J. Nasternak ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Intensive Care ◽  
Cancer Patients ◽  
Medical Management ◽  
Group Versus ◽  
Cost Of Care ◽  
Inpatient Cost ◽  
Intractable Pain ◽  
The Mean ◽  
Intractable Cancer Pain

18520 Background: Long lengths of stay (LOS) and high readmission rates partly explain the high medical costs of treating cancer patients. Uncontrolled pain is the number two reason for hospital readmission. Aggressive measures and treatment strategies for relieving intractable cancer pain can require the implantation and management of intrathecal (IT) drug delivery systems. The objective was to examine LOS, episodes of readmission, intensive care (ICU) stays, and discharge status among patients treated with IT versus comprehensive medical management (CMM) for pain. Methods: Retrospective case-control medical record review methods were employed. Sixty-three randomly selected cancer patients who received an IT were matched on gender, age group, and primary diagnosis to 63 who did not. Results: The total LOS for the 63 non-IT patients was 567 days. The total LOS for the 63 IT patients was 301 days. The mean LOS among the non-IT patients was 9 days. The mean LOS among the IT patients was 4.7 days. Total LOS for the non-IT patients was statistically significantly higher. Among the 63 non-IT patients 94 total inpatient episodes were experienced. Among the 63 IT patients 68 total inpatient episodes were experienced. The likelihood of a non-IT patient readmitting was nine-fold higher than the IT patients and statistically significantly different. The total Intensive Care Unit (ICU) days for the 63 non-IT patients were 60 days. The total ICU days for the 63 IT patients were 30 days. The total ICU for the non-IT patients was not statistically significantly higher. The likelihood of a non-IT patient expiring while an inpatient was fourteen-fold higher than the IT patients and was statistically significantly different. The average cost per episode was 22% higher among the IT group versus the non-IT group. Conclusions: The implantable IT system for pain management among cancer patients experiencing intractable pain may be a significant influence on patient LOS, readmission, and ICU episodes even though it represents a 22% increase in average inpatient costs per episode. Controlled studies examining these hospital indicators as primary outcomes for these patients by evaluating the IT drug delivery system as compared to CMM are warranted. No significant financial relationships to disclose.

Palliative care and end-of-life health utilization in elder patients with pancreatic cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 488-488
Author(s):  
Nizar Bhulani ◽  
Ang Gao ◽  
Arjun Gupta ◽  
Jenny Jing Li ◽  
Chad Guenther ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Cost Of Care ◽  
Care Utilization

488 Background: Prospective trials have shown that palliative care is associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room and Intensive Care utilization and costs in the last 30 days of life were assessed. Statistical analyses were performed with SAS version 9.4 (SAS Institute, Inc., Cary, NC). Results: Of the 72205 patients with pancreatic cancer, 3383 (4.1%) received palliative care. The proportion of patients receiving palliative care increased from 1.8% in 2000 to 7.8% in 2009 (p for trend < 0.001). Patients with palliative care were more likely to be Asian and women. Of those who received palliative care, 73% received it in the last 30 days of life, and only 11% at least 12 weeks before death. The average number of visits to the ED in the last 30 days of life were significantly higher for patients who received palliative care (0.93±0.62) versus those who did not (0.79±0.61), p < 0.001, and had a significantly higher cost of care ($1317 vs $842, p < 0.001). Intensive care unit length of stay in the last 30 days of life did not differ between patients who did and did not receive palliative care (1.14 days vs 1.04 days, p 0.08). Intensive care unit cost of care was significantly higher for patients with palliative care compared to their counterparts ($5202.641 vs $3896.750, p < 0.001). Conclusions: Palliative care use for pancreatic cancer patients has increased between 2000 and 2009 in this study of Medicare patients. However, it was largely offered close to the end of life and was not associated with reduced health care utilization or cost. Early palliative care referral may be more beneficial.

Pancreatic cancer survivorship: Intrathecal drug delivery system for pain management

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14100-14100
Author(s):  
L. J. Stearns ◽  
W. H. Poling ◽  
J. Kiser ◽  
J. Nasternak ◽  
E. Berryman
Keyword(s):  
Drug Delivery ◽  
Pancreatic Cancer ◽  
Pain Management ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Treatment Center ◽  
Celiac Plexus Block ◽  
Maricopa County ◽  
Intrathecal Drug Delivery ◽  
The Mean

14100 Background: Pancreatic cancer is predominantly unresectable at diagnosis and is most frequently fatal. Nationally the average survivorship is 10 months. Among pancreatic cancer patients, pain is associated with decreased survival rates. Quality of life and survivorship are the principal outcome measures for these patients. Successful pain management may be a significant predictor of prolonged survivorship. No study has demonstrated an impact on survivorship secondary to the treatment of pancreatic cancer pain and the use of Intrathecal Drug Delivery Systems (IDDS). Methods: A retrospective chart review identified all pancreatic cancer patients treated at a cancer pain treatment center between January 2002 and June 2005. 43 patients had known dates of diagnosis and known dates of death. The Arizona Department of Health Services Cancer Registry provided similar information for pancreatic cancer patients residing in Maricopa County for that time period. 713 Maricopa county residents had known dates of diagnosis and known dates of death. Results: Among the Maricopa County pancreatic cancer patients, the mean survivorship was 5 months. Among the treatement center patients who did not receive the IDDS for pain, 10 (23.3%), the mean survivorship was 10.8 months. Among the pancreatic cancer patients receiving IDDS for pain management, 33 (76.7%), the mean survivorship was 14.2 months. Mean survivorship among the treatment center patients receiving IDDS for pain management is nearly 3 times greater than the general survivorship of pancreatic cancer patients in Maricopa County. Among the treatement center patients the mean survivorship is nearly 50% greater for patients receiving IDDS versus those that did not. Conclusions: The implantable IDDS for pain management among pancreatic cancer patients may be a significant predictor of increased survivorship. A larger sample size may be needed to detect significant differences in survivorship. Controlled studies examining survivorship as the primary outcome for patients with unresectable pancreatic cancer by evaluating the implantable IDDS as compared to usual care modalities such as comprehensive medical management (CMM) or neurolytic celiac plexus block (NCPB) for pain management are warranted. No significant financial relationships to disclose.

Pancreatic cancer cost-of-care in inpatient setting.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 28-28
Author(s):  
Dhruv Bansal ◽  
Pranshu Bansal ◽  
Vidit Kapoor
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Care ◽  
Cost Of Care ◽  
Inpatient Cost ◽  
Inpatient Setting ◽  
Modest Improvement ◽  
Time Period ◽  
The Mean ◽  
Improvement In Survival ◽  
Mean Cost

28 Background: Pancreatic cancer continues to carry bad prognosis with modest improvement in survival in the last decade. SEER analysis from 2006-2012 shows a 5-year survival of 7.7% for pancreatic cancer and number of new diagnoses were 11.3 per 100,000 U.S. population in 2003 and 12.7 in 2013. The mortality rate was 10.5 and 10.8 per 100,000 during the same time period. In spite of modest improvement in survival, the cancer care costs including pancreatic cancer continue to rise and inpatient costs contribute a major chunk to cancer care which is often ignored. Methods: We used National Inpatient Sample (NIS) to extract data for patients hospitalized with primary diagnosis of pancreatic cancer using clinical classification software code 17, and corresponding ICD9 codes for the years 2004-2013. NIS is a nationally representative survey of hospitalizations conducted by the Healthcare Cost and Utilization Project. It represents 20% of all hospital data in the US. Trend of rate of hospitalization, mean length of stay (LOS), and mean cost of hospitalization were analyzed. Results: The rate of hospitalization for pancreatic cancer were 11.0 +/-0.5 in 2004 and 11.0 +/-0.3 per 100,00 hospitalizations in 2013. Mean LOS declined from 8.978 +/-0.141 to 7.616 +/-0.105 days between 2004-2013. In the same time period the mean cost of hospital stay increased from $39,533 +/-1,514 to $74,216 +/- 2,408. Conclusions: In the years 2004-2013 the rate of hospitalization for pancreatic cancer remained stable (z test p = 1.0), LOS decreased significantly by approximately 15% (z test p < 0.001), but the mean cost of hospitalization showed the most significant increase throughout the decade with a mean increase of approximately 47% (p < 0.001) in hospital costs. National inflation rate was 23.3% during this time. The gains made in decreasing the LOS has not lead to a decrease in inpatient cost of care. Pancreatic cancer treatment lags behind other cancers with dismal survival rates, and combination chemotherapies are increasingly being used which may add to inpatient cost in future as well although results at this time remain modest. Further research efforts to better identify the factors contributing to inpatient cost should be undertaken.

Randomized Clinical Trial of an Implantable Drug Delivery System Compared With Comprehensive Medical Management for Refractory Cancer Pain: Impact on Pain, Drug-Related Toxicity, and Survival

2002 ◽  
Vol 20 (19) ◽  
pp. 4040-4049 ◽  
Author(s):  
Thomas J. Smith ◽  
Peter S. Staats ◽  
Timothy Deer ◽  
Lisa J. Stearns ◽  
Richard L. Rauck ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Clinical Trial ◽  
Cancer Pain ◽  
Randomized Clinical Trial ◽  
Medical Management ◽  
Pain Control ◽  
Clinical Success ◽  
Pain Visual Analog Scale ◽  
The Mean ◽  
Toxicity Scores

PURPOSE: Implantable intrathecal drug delivery systems (IDDSs) have been used to manage refractory cancer pain, but there are no randomized clinical trial (RCT) data comparing them with comprehensive medical management (CMM). PATIENTS AND METHODS: We enrolled 202 patients on an RCT of CMM versus IDDS plus CMM. Entry criteria included unrelieved pain (visual analog scale [VAS] pain scores ≥ 5 on a 0 to 10 scale). Clinical success was defined as ≥ 20% reduction in VAS scores, or equal scores with ≥ 20% reduction in toxicity. The main outcome measure was pain control combined with change of toxicity, as measured by the National Cancer Institute Common Toxicity Criteria, 4 weeks after randomization. RESULTS: Sixty of 71 IDDS patients (84.5%) achieved clinical success compared with 51 of 72 CMM patients (70.8%, P = .05). IDDS patients more often achieved ≥ 20% reduction in both pain VAS and toxicity (57.7% [41 of 71] v 37.5% [27 of 72], P = .02). The mean CMM VAS score fell from 7.81 to 4.76 (39% reduction); for the IDDS group, the scores fell from 7.57 to 3.67 (52% reduction, P = .055). The mean CMM toxicity scores fell from 6.36 to 5.27 (17% reduction); for the IDDS group, the toxicity scores fell from 7.22 to 3.59 (50% reduction, P = .004). The IDDS group had significant reductions in fatigue and depressed level of consciousness (P < .05). IDDS patients had improved survival, with 53.9% alive at 6 months compared with 37.2% of the CMM group (P = .06). CONCLUSION: IDDSs improved clinical success in pain control, reduced pain, significantly relieved common drug toxicities, and improved survival in patients with refractory cancer pain.

A cluster-controlled clinical trial of two prophylactic silicone sacral dressings to prevent sacral pressure injuries in critically ill patients

2019 ◽  
pp. 21-26 ◽  
Author(s):  
Monica Stankiewicz ◽  
Jodie Gordon ◽  
Joel Dulhunty ◽  
Wendy Brown ◽  
Hamish Pollock ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Intensive Care ◽  
Similar Efficacy ◽  
Care Patient ◽  
Controlled Clinical Trial ◽  
Cost Difference ◽  
Increased Risk ◽  
Pressure Injury ◽  
Risk Patients ◽  
The Mean

Objective Patients in the intensive care unit (ICU) have increased risk of pressure injury (PI) development due to critical illness. This study compared two silicone dressings used in the Australian ICU setting for sacral PI prevention. Design A cluster-controlled clinical trial of two sacral dressings with four alternating periods of three months' duration. Setting A 10-bed general adult ICU in outer-metropolitan Brisbane, Queensland, Australia. Participants Adult participants who did not have a sacral PI present on ICU admission and were able to have a dressing applied for more than 24 hours without repeated dislodgement or soiling in a 24-hour period (>3 times). Interventions Dressing 1 (Allevyn Gentle Border Sacrum™, Smith & Nephew) and Dressing 2 (Mepilex Border Sacrum™, Mölnlycke). Main outcomes measures The primary outcome was the incidence of a new sacral PI (stage 1 or greater) per 100 dressing days in the ICU. Secondary outcomes were the mean number of dressings per patient, the cost difference of dressings to prevent a sacral PI and product integrity. Results There was no difference in the incidence of a new sacral PI (0.44 per 100 dressing days for both products, p = 1.00), the mean number of dressings per patient per day (0.50 for both products, p = 0.51) and product integrity (85% for Dressing 1 and 84% for Dressing 2, p = 0.69). There was a dressing cost difference per patient (A$10.29 for Dressing 1 and A$28.84 for Dressing 2, p < 0.001). Conclusions Similar efficacy, product use and product integrity, but differential cost, were observed for two prophylactic silicone dressings in the prevention of PIs in the intensive care patient. We recommend the use of sacral prophylactic dressings for at-risk patients, with the choice of product based on ease of application, clinician preference and overall cost-effectiveness of the dressing.

Correlation of AGR2 expression with the incidence of metastasis in luminal breast cancer

2021 ◽  
pp. 1-5
Author(s):  
David Samuel Kereh ◽  
John Pieter ◽  
William Hamdani ◽  
Haryasena Haryasena ◽  
Daniel Sampepajung ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Mean Value ◽  
Rank Test ◽  
Luminal Breast Cancer ◽  
P Value ◽  
Strong Positive Correlation ◽  
Breast Cancer Patients ◽  
The Mean ◽  
Spearman Test

BACKGROUND: AGR2 expression is associated with luminal breast cancer. Overexpression of AGR2 is a predictor of poor prognosis. Several studies have found correlations between AGR2 in disseminated tumor cells (DTCs) in breast cancer patients. OBJECTIVE: This study aims to determine the correlation between anterior Gradient2 (AGR2) expression with the incidence of distant metastases in luminal breast cancer. METHODS: This study was an observational study using a cross-sectional method and was conducted at Wahidin Sudirohusodo Hospital and the network. ELISA methods examine AGR2 expression from blood serum of breast cancer patients. To compare the AGR2 expression in metastatic patients and the non-metastatic patient was tested with Mann Whitney test. The correlation of AGR2 expression and metastasis was tested with the Rank Spearman test. RESULTS: The mean value of AGR2 antibody expression on ELISA in this study was 2.90 ± 1.82 ng/dl, and its cut-off point was 2.1 ng/dl. Based on this cut-off point value, 14 subjects (66.7%) had overexpression of AGR2 serum ELISA, and 7 subjects (33.3%) had not. The mean value AGR2 was significantly higher in metastatic than not metastatic, 3.77 versus 1.76 (p < 0.01). The Spearman rank test obtained a p-value for the 2 tail test of 0.003 (p < 0.05), which showed a significant correlation of both, while the correlation coefficient of 0.612 showed a strong positive correlation of AGR2 overexpression and metastasis. CONCLUSIONS: AGR2 expression is correlated with metastasis in Luminal breast cancer.

scholarly journals Budget Impact Analysis of Anticoagulation Clinics in Patients with Atrial Fibrillation under Chronic Therapy with Oral Anticoagulants

2021 ◽  
Vol 12 ◽  
pp. 215013272110002
Author(s):  
William Uribe-Arango ◽  
Juan Manuel Reyes Sánchez ◽  
Natalia Castaño Gamboa
Keyword(s):  
Atrial Fibrillation ◽  
Impact Analysis ◽  
Budget Impact ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Group Versus ◽  
Cost Of Care ◽  
Chronic Therapy ◽  
Colombian Government ◽  
The Cost

Objectives To assess budget impact of the implementation of an anticoagulation clinic (AC) compared to usual care (UC), in patients with non-valvular atrial fibrillation (NVAF). Method A decision tree was designed to analyze the cost and events rates over a 1-year horizon. The patients were distributed according to treatment, 30% Direct Oral Anticoagulant (DOAC) regimens and the rest to warfarin. The thromboembolism and bleeding were derived from observational studies which demonstrated that ACs had important impact in reducing the frequency of these events compared with UC, due to higher adherence with DOACs and proportion of time in therapeutic range (TTR) with warfarin. Costs were derived from the transactional platform of Colombian government, healthcare authority reimbursement and published studies. The values were expressed in American dollars (USD). The exchanged rate used was COP $3.693 per dollar. Results During 1 year of follow-up, in a cohort of 228 patients there were estimated 48 bleedings, 6 thromboembolisms in AC group versus 84 bleedings, and 12 thromboembolisms events in patients receiving UC. Total costs related to AC were $126 522 compared with $141 514 in UC. The AC had an important reduction in the cost of clinical events versus UC ($52 085 vs $110 749) despite a higher cost of care facilities ($74 436 vs $30 765). A sensibility analysis suggested that in the 83% of estimations, the AC produced savings varied between $27 078 and $135 391. Conclusions This study demonstrated that AC compared with UC, produced an important savings in the oral anticoagulation therapy for patients with NVAF.

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