The financial impact of fractionation scheme and treatment planning method for rectal cancer in the United States.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6518-6518
Author(s):  
Assaf Moore ◽  
Robert Benjamin Den ◽  
Noa Gordon ◽  
Michal Sarfaty ◽  
Yulia Kundel ◽  
...  
Keyword(s):  
United States ◽  
Rectal Cancer ◽  
Treatment Planning ◽  
Locally Advanced ◽  
The United States ◽  
Planning Method ◽  
Total Cost ◽  
The Us ◽  
Fractionation Scheme ◽  
The Cost

6518 Background: Preoperative long-course chemoradiotherapy (CRT) and short-course radiotherapy (SCR) for locally advanced rectal cancer (LARC) were found to have equivalent outcomes in three randomized trials. SCR may have lower acute toxicity and the down-staging following CRT is more well-established. At present, SCR is frequently used in Europe but has not been widely adopted in the United States (US). It is standard to deliver radiotherapy by 3D planning, while the use of Intensity-modulated radiotherapy (IMRT) is controversial. In recent years there has been an increasing focus on understanding the cost and value of cancer care. In this study we aimed to assess the economic impact of fractionation scheme and treatment planning method for payers in the US. Methods: We performed a population-based analysis of the total cost of radiotherapy for LARC in the US annually. The national annual target population of patients was calculated using the Surveillance, Epidemiology, and End Results (SEER) database. Treatment costs for various fractionation schemes were based on billing codes and 2018 pricing by Medicare's Hospital Outpatient Prospective Payment System (OPPS). The cost of chemotherapy was based on the Payment Allowance Limits for Medicare Part B Drugs by Centers for Medicare and Medicaid Services (CMS). Results: We estimate that 12,945 patients with LARC are treated with radiotherapy annually in the US. The cost of CRT with 3-D or IMRT is US$ 15,881.76 and US$ 23,744.82 per patient, respectively. With 3-D SCR the cost is US$ 5,457 per patient. The use of SCR would lead to 64-77% annual savings of US$ 125,701,387 - US$ 236,727,934 in the US compared with 3-D and IMRT based CRT, respectively. IMRT based planning increases the total cost of CRT by 49% and if adopted widely would lead to an excess cost of US$ 101,787,312 annually. Conclusions: SCR may have the potential to save in the region of US$ 0.12-0.23 billion annually in the US, likely without impacting outcomes. Lack of evidence showing benefit with costly IMRT should limit its use to clinical trials. SCR may also lead to lower personal financial toxicity. It would be reasonable for public and private payers to consider which type of radiation is most suited to reimbursement.

The Financial Impact of Fractionation Scheme and Treatment Planning Method for Rectal Cancer in the United States

2019 ◽  
Vol 18 (3) ◽  
pp. 209-217 ◽  
Author(s):  
Assaf Moore ◽  
Robert B. Den ◽  
Noa Gordon ◽  
Michal Sarfaty ◽  
Yulia Kundel ◽  
...  
Keyword(s):  
United States ◽  
Rectal Cancer ◽  
Treatment Planning ◽  
The United States ◽  
Planning Method ◽  
Financial Impact ◽  
Fractionation Scheme

Fractionation scheme and treatment planning method for early glottic cancer in the United States: Economic impact of different medical decisions

Head & Neck ◽  
2020 ◽  
Vol 42 (8) ◽  
pp. 1713-1720 ◽  
Author(s):  
Assaf Moore ◽  
Robert B. Den ◽  
Aaron Popovtzer ◽  
Hadar Goldvaser ◽  
Noa Gordon ◽  
...  
Keyword(s):  
United States ◽  
Economic Impact ◽  
Treatment Planning ◽  
The United States ◽  
Planning Method ◽  
Glottic Cancer ◽  
Medical Decisions ◽  
Early Glottic Cancer ◽  
Fractionation Scheme

scholarly journals The comparison of vaccine hesitancy of COVID-19 vaccination in China and the United States

2021 ◽  
Author(s):  
Taoran Liu ◽  
Zonglin He ◽  
Jian Huang ◽  
Ni Yan ◽  
Qian Chen ◽  
...  
Keyword(s):  
United States ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Discrete Choice ◽  
Choice Experiments ◽  
The United States ◽  
Discrete Choice Experiments ◽  
Vaccine Hesitancy ◽  
The Us ◽  
The Cost

AbstractObjectivesTo investigate the differences in vaccine hesitancy and preference of the currently available COVID-19 vaccines between two countries, viz. China and the United States (US).MethodA cross-national survey was conducted in both China and the US, and discrete choice experiments as well as Likert scales were utilized to assess vaccine preference and the underlying factors contributing to the vaccination acceptance. A propensity score matching (PSM) was performed to enable a direct comparison between the two countries.ResultsA total of 9,077 (5,375 and 3,702, respectively, from China and the US) respondents have completed the survey. After propensity score matching, over 82.0% respondents from China positively accept the COVID-19 vaccination, while 72.2% respondents form the US positively accept it. Specifically, only 31.9% of Chinese respondents were recommended by a doctor to have COVID-19 vaccination, while more than half of the US respondents were recommended by a doctor (50.2%), local health board (59.4%), or friends and families (64.8%). The discrete choice experiments revealed that respondents from the US attached the greatest importance to the efficacy of COVID-19 vaccines (44.41%), followed by the cost of vaccination (29.57%), whereas those from China held a different viewpoint that the cost of vaccination covers the largest proportion in their trade-off (30.66%), and efficacy ranked as the second most important attribute (26.34%). Also, respondents from China tend to concerned much more about the adverse effect of vaccination (19.68% vs 6.12%) and have lower perceived severity of being infected with COVID-19.ConclusionWhile the overall acceptance and hesitancy of COVID-19 vaccination in both countries are high, underpinned distinctions between countries are observed. Owing to the differences in COVID-19 incidence rates, cultural backgrounds, and the availability of specific COVID-19 vaccines in two countries, the vaccine rollout strategies should be nation-dependent.

scholarly journals On the ethics of doctors in capitalist countries

1981 ◽  
Vol 62 (5) ◽  
pp. 80-83
Author(s):  
S. Ya. Chikin
Keyword(s):  
United States ◽  
Surgical Intervention ◽  
The United States ◽  
For Profit ◽  
Us Congress ◽  
The Us ◽  
The Cost

In 1977, the US Congress published statistics on the operation of surgical clinics in many cities in the country. These materials cannot be read without a shudder. They once again proved that American doctors are no different from businessmen in their passion for profit. The report's conclusion was very sad. He testified that up to three million unjustified surgeries are performed annually in the United States. Naturally, they are not undertaken for the sake of the patient's health, but in order to present a more weighty bill to the patient, because the cost of the simplest surgical intervention is now estimated at at least $ 1000.

scholarly journals Challenges and solutions in the design and execution of the PROSPECT Phase II/III neoadjuvant rectal cancer trial (NCCTG N1048/Alliance)

2019 ◽  
Vol 16 (2) ◽  
pp. 165-175 ◽  
Author(s):  
Deborah Schrag ◽  
Martin Weiser ◽  
Leonard Saltz ◽  
Harvey Mamon ◽  
Marc Gollub ◽  
...  
Keyword(s):  
United States ◽  
Rectal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Phase Ii ◽  
Locally Advanced ◽  
Symptom Burden ◽  
The United States ◽  
Distant Recurrence ◽  
Neoadjuvant Chemoradiation ◽  
Eligibility Criteria

Background More than half of the 40,000 incident rectal cancer patients in the United States each year are diagnosed at clinical stage II and III (locally advanced stage). For this group, high rates of cure can be achieved with the combination of pelvic radiation and sensitizing 5-fluorouracil (chemoradiation), surgery and chemotherapy, but treatment is long, arduous and toxicities are substantial. The PROSPECT trial (N1048, NCT01515787) was designed to determine whether neoadjuvant chemotherapy with 5-fluorouracil and oxaliplatin (FOLFOX) could be used as an alternative to neoadjuvant chemoradiation without compromising treatment outcomes and to spare these patients excess toxicity. The statistical design balanced the twin co-primary goals of achieving low local and distant recurrence rates. Study design features contended with the need for stringent safeguards given limited phase II data, the need for straightforward criteria to facilitate both accrual and protocol fidelity and the importance of patients’ perspectives on symptom burden and treatment toxicity. Methods PROSPECT is an ongoing multi-site two-group seamless phase II/III randomized trial comparing standard neoadjuvant chemoradiation versus neoadjuvant chemotherapy with selective use of chemoradiation for patients with locally advanced rectal cancer. Challenges addressed in the design and conduct of PROSPECT have included the following: (1) setting safety thresholds given limited single-center phase II data, (2) establishing workable eligibility criteria, (3) balancing competing time to local and distant recurrence as co-primary endpoints and (4) obtaining reliable and complete data for patients’ symptom burden. The design and implementation challenges, choices, modifications and their implications for the design of future national cooperative group clinical trials are presented. Results PROSPECT incorporated stringent thresholds for both complete surgical resection (R0) and the time to local recurrence as early stopping rules. When predetermined stopping criteria were not met after evaluation of the first 366 participants in the randomized phase II, the study transitioned seamlessly to phase III with cumulative accrual of over 1000 participants. Eligibility criteria stipulating rectal tumor location based on distance from the anal verge were unworkable, and the protocol was amended to a more pragmatic approach that assigned surgeons with primary responsibility for determining eligibility. Central radiology review was feasible and in some cases prompted discontinuation of protocol treatment. Participation in toxicity reporting using the National Cancer Institute’s Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events was uniformly high and was well accepted by participants from over 200 sites in the United States, Canada and Switzerland. Conclusion The strategies used to overcome these obstacles may inform the design of other studies that involve multi-modality treatment interventions, particularly trials where implementation of consistent criteria for eligibility and outcomes across hundreds of practice settings is necessary.

Early mortality after resection of locally advanced rectal cancer in elderly United States patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11529-11529
Author(s):  
Helmneh M. Sineshaw ◽  
K Robin Yabroff ◽  
Vassiliki Liana Tsikitis ◽  
Ahmedin Jemal ◽  
Timur Mitin
Keyword(s):  
United States ◽  
Rectal Cancer ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
The United States ◽  
Locally Advanced Rectal Cancer ◽  
Early Mortality ◽  
Older Age ◽  
Case Volume ◽  
Comorbidity Score

11529 Background: Early mortality after resection of locally advanced rectal cancer in patients age 75 and older has not been studied in the United States. This information could inform clinical decision-making for patients who achieve complete clinical response after neoadjuvant therapy and consider watchful waiting versus surgical resection. Methods: Using the National Cancer Data Base, we identified patients age 75 years and older who underwent surgery for clinical stage II or III rectal cancer between 2004-2015. We performed multivariable logistic regression analyses to assess associations between patient and facility characteristics and 30-day, 90-day, and 6-month mortality. Results: Among 11,326 patients, 94% underwent resection and the remaining 6% underwent local excision. Overall early mortality rates after surgery were 4%, 7.6% and 11% for 30-day, 90-day and six-month, respectably. Six-month mortality varied by age subgroup (8% in 75-79 years old to 17.7% in 85 years and older), and comorbidity score (9.5% for comorbidity score = 0 to 18.5% for comorbidity score ≥ 2). Between 2004 and 2015, six-month mortality declined significantly from 11.9% in 2004-2007 to 9.8% in 2012-2015 ( P trend = 0.0029), with the decline larger among patients age 85 years and older (from 19.4% in 2004-2007 to 15.3% in 2012-2015, P trend = 0.0377). In the multivariable analysis, older age, higher comorbidity score, and lower facility case volume were significantly associated with higher odds of six-month mortality. Patients treated at National Cancer Institute (NCI) designated centers had 32% lower odds of six-month mortality compared with those treated at non-NCI designated teaching/research centers. Conclusions: Post-operative six-month mortality among patients age 75 years and older with locally advanced rectal cancer in the US declined steadily over the past decade. Older age, high comorbidity score, and low facility case volume were associated with higher six-month mortality after surgery. Additional efforts are needed to guide elderly patients and their physicians in discussing treatment options for locally advanced rectal cancer.

scholarly journals Human papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. e1003534
Author(s):  
Jane J. Kim ◽  
Kate T. Simms ◽  
James Killen ◽  
Megan A. Smith ◽  
Emily A. Burger ◽  
...  
Keyword(s):  
United States ◽  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Hpv Vaccination ◽  
The United States ◽  
The Us ◽  
Age Limit ◽  
The Cost

Background A nonavalent human papillomavirus (HPV) vaccine has been licensed for use in women and men up to age 45 years in the United States. The cost-effectiveness of HPV vaccination for women and men aged 30 to 45 years in the context of cervical cancer screening practice was evaluated to inform national guidelines. Methods and findings We utilized 2 independent HPV microsimulation models to evaluate the cost-effectiveness of extending the upper age limit of HPV vaccination in women (from age 26 years) and men (from age 21 years) up to age 30, 35, 40, or 45 years. The models were empirically calibrated to reflect the burden of HPV and related cancers in the US population and used standardized inputs regarding historical and future vaccination uptake, vaccine efficacy, cervical cancer screening, and costs. Disease outcomes included cervical, anal, oropharyngeal, vulvar, vaginal, and penile cancers, as well as genital warts. Both models projected higher costs and greater health benefits as the upper age limit of HPV vaccination increased. Strategies of vaccinating females and males up to ages 30, 35, and 40 years were found to be less cost-effective than vaccinating up to age 45 years, which had an incremental cost-effectiveness ratio (ICER) greater than a commonly accepted upper threshold of $200,000 per quality-adjusted life year (QALY) gained. When including all HPV-related outcomes, the ICER for vaccinating up to age 45 years ranged from $315,700 to $440,600 per QALY gained. Assumptions regarding cervical screening compliance, vaccine costs, and the natural history of noncervical HPV-related cancers had major impacts on the cost-effectiveness of the vaccination strategies. Key limitations of the study were related to uncertainties in the data used to inform the models, including the timing of vaccine impact on noncervical cancers and vaccine efficacy at older ages. Conclusions Our results from 2 independent models suggest that HPV vaccination for adult women and men aged 30 to 45 years is unlikely to represent good value for money in the US.

scholarly journals Information Technology vs Environmental Health

2004 ◽  
Vol 3 (1) ◽  
pp. 20-28
Author(s):  
Shobha S. V.
Keyword(s):  
United States ◽  
Developing Countries ◽  
Inorganic Compounds ◽  
The United States ◽  
Hazardous Substances ◽  
Labor Laws ◽  
Unique Problem ◽  
The Us ◽  
The Cost ◽  
Toxic Fumes

Personal computers (PC's), cell phones, fax machines and related electronic equipment, have become a part of modern life in developed and many developing countries. While theses devices have improved our productivity, they also have created a unique problem of disposal of the discarded electronic or e-waste. In the United States, PCs become outdates within an average period of 3-4 years. Continued technological innovations, aided by lower price of the new models, further reduce the useful life of PCs to an even shorter period. It is estimated that in the US alone, during the 10 year period. 1997-2007, an estimated 500 million PCs will become obsolete, awaiting disposal. Owing to the toxic nature of many heavy metals, organic, and inorganic compounds that go into manufacturing the computer and the monitor, their disposal in a landfill or by incineration is not a preferred option. Recyclers attempt to salvage as many of the re-usable materials as possible. However, the labor-intensive process makes computer recycling cost-prohibitive in the United States. This has resulted in shipping the obsolete PCs to countries like Bangladesh, China and India. While this practice enables the domestic recycling companies to reduce the cost, it creates serious health and environmental problems for the workers in developing countries. Generally, environmental and labor laws in such countries are not very specific and even where they are, their enforcement is very lax. Such situations lead top recycling crews working in makeshift factories with hardly any provisions to protect them from exposure to hazardous substances primarily through inhalation of the toxic fumes causing cancer and other serious health problems.

scholarly journals Reining In Patent Costs

2009 ◽  
Vol 131 (08) ◽  
pp. 36-37 ◽  
Author(s):  
Kirk Teska
Keyword(s):  
United States ◽  
Average Cost ◽  
Patent Application ◽  
The United States ◽  
Fixed Cost ◽  
Total Cost ◽  
Patent Attorney ◽  
Utility Patent ◽  
Basic Patent ◽  
The Cost

This paper focuses on that one can make a fortune if one holds a patent for something that everybody wants; and when one is rich and the patent expires, then in general, the society can benefit from what one invented. According a 2007 survey, the average cost for a utility patent application in the United States is around $12,000. By the time the patent is granted, the total cost could easily exceed $20,000. As for basic patent application drafting information, provide any information that the attorney will need to set the deadline for filing the application. List the names, residential addresses, and citizenship of all the likely inventors. List and provide a copy of all relevant prior papers and patents you know about that are related to the invention. Many companies use “invention disclosure” forms for these purposes. If the patent attorney is willing, ask for a discount for multiple applications and/or fixed cost applications. The overall cost may not be that much lower, but at least the cost is known ahead of time and can budget the patenting efforts accordingly.

scholarly journals Assessing the Costs of Screening for Ovarian Cancer in the United States: An Evolving Analysis

Diagnostics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 67
Author(s):  
Justin W. Gorski ◽  
McKell Quattrone ◽  
John R. van Nagell ◽  
Edward J. Pavlik
Keyword(s):  
United States ◽  
Ovarian Cancer ◽  
Screening Program ◽  
Early Stage ◽  
The United States ◽  
Cost Of Care ◽  
Ovarian Cancer Screening ◽  
Total Cost ◽  
Program Costs ◽  
The Cost

The primary objective of this study is to provide an updated analysis of the cost of screening for ovarian cancer in the United States. Here, we use updated information from the University of Kentucky Ovarian Cancer Screening Trial in conjunction with new modifying factors such as U.S. national estimates of the cost of care (Truven Health MarketScan Database), recently published estimates of earnings lost due to ovarian cancer death and estimates of federal income taxes paid on those earnings. In total, 326,998 screens were performed during the Kentucky trial from 1987 to 2019. At a cost of $56 per screen, we estimate that the total base cost to operate the program over the last 32 years is $18,311,888. When accounting for the surgical cost of 381 false-positive cases, the total cost of the screening program increases by $3,030,474. However, these costs are offset by the benefit of treating more early-stage ovarian cancer in the screened population, with a total cost advantage of $4,016,475 at our institution (Kentucky) or $1,525,050 ($725,700–$3,312,650) (U.S.) nationally. Additionally, program costs are offset by approximately $3,549,000 due to the potential earnings gained by the 26 women whose lives have been saved with screening. Furthermore, the cost of the program is offset by the federal tax dollars paid on the recovered earnings and amounts to $383,292. Ultimately, the net adjusted total cost of the Kentucky screening program is an estimated $13,393,595 at our institution or $15,885,020 ($13,978,068–$16,799,083) nationally. Thus, the adjusted cost per screen is an estimated $40.96 in Kentucky or $48.58 ($42.75–$51.37) nationally.

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