Healthcare utilization and costs in hepatocellular carcinoma (HCC) patients treated at a large referral center in Washington (WA) State.

e16149 Background: Though the treatment landscape for HCC has changed significantly in the last several years with the refinement of liver-directed therapy techniques and the introduction of multiple new drugs, few studies have investigated the impact of the changing treatment landscape on lifetime treatment costs, particularly in Barcelona Clinic Liver Cancer (BCLC) stage C disease. We therefore sought to investigate real-world clinical characteristics, treatment patterns, healthcare use, and costs in patients with HCC treated at a single high-volume institution in WA. Methods: We conducted a retrospective cohort study of patients diagnosed with HCC between 2007 and 2018 at a single clinical cancer center using a database containing abstracted data from the electronic medical record (EMR) linked to cancer registry data and health claims from commercial insurance plans, Medicare, and Medicaid. We described clinical characteristics, including BCLC stage and Child Pugh score, and treatment patterns. We investigated the mean per patient lifetime treatment costs by BCLC stage using Kaplan-Meier cost estimator methods. Results: The final cohort included 215 patients, majority white (71%), male (68%), and with underlying hepatitis C (61%). Most patients had either Child Pugh A (76%) or B (20%) liver disease and BCLC A (45%), B (20%), or C (19%) stage HCC. Only 40% of BCLC C patients received systemic chemotherapy. Mean per patient lifetime costs were highest in BCLC A ($289,318) and BCLC C ($255,430) patients and lowest in BCLC D ($123,701) patients (Table). Surgical costs, hospital costs, imaging, and outpatient visits were the major contributors to total lifetime costs in BCLC A patients. Chemotherapy costs were highest in BCLC C patients, but still were not the predominant area of spending. Conclusions: In a WA state cohort of HCC patients, mean lifetime costs were highest in patients with BCLC A disease, largely driven by surgery and hospital costs. As utilization of newer and less toxic therapies in BCLC C patients increases, mean lifetime costs in this group may surpass other stages.[Table: see text]

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The lifetime cost estimation of human papillomavirus-related diseases in China: a modeling study

Journal of Translational Internal Medicine ◽

10.2478/jtim-2021-0039 ◽

2021 ◽

Vol 9 (3) ◽

pp. 200-211

Author(s):

Wenpei Ding ◽

Yue Ma ◽

Chao Ma ◽

Daniel C Malone ◽

Aixia Ma ◽

...

Keyword(s):

Human Papillomavirus ◽

Distant Metastasis ◽

Carcinoma In Situ ◽

Lifetime Cost ◽

Hpv Infection ◽

Treatment Costs ◽

Lifetime Costs ◽

Local Metastasis ◽

Lifetime Treatment

Abstract Objectives To estimate the lifetime treatment costs of patients with human papillomavirus (HPV) infection-related diseases in China and to provide cost estimates for the economic evaluation of HPV intervention strategies. Methods We extracted real-world hospital data from 2012 to 2019 and screened for subjects who met the criteria of clinical diagnosis of HPV-related diseases to obtain country-specific inputs into a Markov decision model. The model simulated lifetime treatment costs for HPV from the perspective of a national payer. A 5% discount rate was applied. Costs were converted and inflated to 2020 US dollars (USD) Results Using 2021 as the base year, the lifetime costs per patient for carcinoma in situ, local metastasis, and distant metastasis cervical cancer are $24,208 (95%CI: 18,793–30,897), $19,562 (95%CI: 14,456–25,567), and $17,599 (95%CI: 10,604–25,807), respectively. For carcinoma in situ, local metastasis, and distant metastasis vaginal cancer, the lifetime costs are $17,593 (95%CI: 14,962–23,596), $17,120 (95%CI: 13,215–22,417), and $22,411 (95%CI: 12,172–22,249), respectively. The base-case lifetime cost per patient for different stages of vulvar cancer/penile cancer/anal cancer/oral cancer/oropharyngeal cancer/laryngeal cancer falls within $17,120–$58,236. Conclusions Using real-world data, we calculated lifetime treatment costs of HPV-related cancer in China and found that the lifetime cost for patients exceeded $17,000 for various stages of disease. The national burden of HPV-related disease could be significantly reduced by eliminating HPV infection.

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Clinical characteristics, treatment patterns, and 60-day outcomes of patients hospitalized for worsening heart failure: insights from the IMPACT-HF registry

Journal of Cardiac Failure ◽

10.1016/s1071-9164(03)00229-x ◽

2003 ◽

Vol 9 (5) ◽

pp. S72

Author(s):

Christopher M. O'Connor ◽

Wendy A. Gattis ◽

Dianne S. Gallup ◽

Augustine Agocha ◽

Christopher S. Brown ◽

...

Keyword(s):

Heart Failure ◽

Clinical Characteristics ◽

Treatment Patterns ◽

The Impact

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Effect of New Institutional Algorithm for Chemotherapy Induced Anemia (CIA) on Erythropoiesis-Stimulating Agent Treatment Patterns and Costs in Lymphoma Patients

Blood ◽

10.1182/blood.v112.11.1299.1299 ◽

2008 ◽

Vol 112 (11) ◽

pp. 1299-1299

Author(s):

Aditya D. Raju ◽

Lal S. Lal ◽

Lesley-Ann Miller ◽

Hua Chen ◽

Sujit S Sansgiry

Keyword(s):

Treatment Patterns ◽

Cancer Center ◽

Control Group ◽

Chi Square ◽

University Of Texas ◽

Institutional Practice ◽

Significant Difference ◽

Study Population ◽

The Mean ◽

The Impact

Abstract Recently there has been accumulating data regarding the increased risks of mortality, thrombosis, cardiovascular events, and of possible tumor promotion when administering erythropoiesis-stimulating agents (ESAs) to a target hemoglobin (Hgb) level of 12 g/dL. In response to this evidence, the FDA mandated a Black Box warning and the CMS mandated changes in coverage for ESAs. Subsequently, in December, 2007, the University of Texas M.D. Anderson Cancer Center (M. D. Anderson) developed and implemented an institutional practice algorithm to advise physicians regarding treatment of CIA, which included recommendations for the initiation and continued use of ESAs. The objective of this study was to assess the impact of the new institutional practice algorithm on the treatment patterns and costs of CIA in lymphoma patients. The study design was a retrospective study with a historical control group. The historical controls (pre-group) consisted of lymphoma patients diagnosed with CIA between January 1, 2007–April 30, 2007 and the cases (post-group) consisted of lymphoma patients diagnosed with CIA between January 1, 2008–April 30, 2008, who were all followed for a period of up to 16 weeks. Patient demographics, chemotherapy type, ESA type and dosage, transfusions received, Hgb values at the time of ESA usage and transfusions (for all doses and transfusions received at the institution during the study period), and costs for ESA treatment and transfusions were extracted from patient medical charts and institutional databases at M. D. Anderson. Descriptive statistics, t-tests, Mann- Whitney U, and chi-square analyses were conducted to evaluate the study objectives. The study population consisted of 154 patients; 90 patients in the pre-group and 64 patients in the post-group. Both groups had similar demographic and baseline clinical characteristics. In the post period, though there was a significant decrease in the overall amount of ESA units dispensed per patient (p=0.0125), there was an increase in the amount of ESA units dispensed in the first eight weeks of treatment (p=0.03), indicating potentially less use of outside pharmacies. There was a significant decrease in the mean Hgb at the time of ESA usage, from 9.59g/dL to 8.98g/dL (p<0.0001). The proportion of patients who received an ESA at a Hgb level > 10 g/dL decreased significantly, from 66% to 17% (p<0.0001). There was no significant difference in the mean Hgb level at week 4 of therapy, which may indicate that patients were not clinically affected by the change in practice. There was also no significant difference in the number of transfusions administered, or the costs associated with the treatment of CIA in the study population. The results indicate that the new institutional algorithm was effective in altering the treatment patterns of CIA with respect to the ESA units prescribed and dispensed and the hemoglobin levels at the time of ESA usage in lymphoma patients.

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Treatment Patterns and Intensity Differ between Pediatric and Adult Centers in AYA with Hodgkin's Lymphoma but Result in Equivalent Outcomes: A Population-Based Study Using the IMPACT Cohort

Blood ◽

10.1182/blood-2018-99-117321 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 831-831 ◽

Cited By ~ 1

Author(s):

Sumit Gupta ◽

Nancy Baxter ◽

Jason Pole ◽

Chenthila Nagamuthu ◽

Cindy Lau ◽

...

Keyword(s):

Community Hospital ◽

Population Based ◽

Treatment Patterns ◽

Cancer Center ◽

Treatment Intensity ◽

Community Hospitals ◽

Cancer Centers ◽

Multivariable Analyses ◽

The Impact ◽

To Receive

Abstract Background: Hodgkin's lymphoma (HL) is one of the most common cancers in adolescents and young adults (AYA). Unlike acute lymphoblastic leukemia, few studies have compared AYA HL outcomes between pediatric and adult centers, or pediatric and adult protocols. Recently, a comparison of AYA (17-21 years) treated on a pediatric COG trial vs. an adult ECOG trial demonstrated superior survival in AYA treated on the pediatric trial, but other studies have not demonstrated a treatment center disparity. None of these studies were population-based. We therefore compared treatment patterns, intensity, and outcomes between AYA HL treated at pediatric vs. adult centers using a population-based clinical database. Methods: The IMPACT Cohort comprises all Ontario, Canada AYA aged 15-21 years diagnosed with one of six common cancers (including HL) between 1992-2012. Detailed demographic, disease, treatment, and outcome data were collected through chart abstraction and validated by content experts. Locus of cancer care (pediatric vs. adult cancer center vs. adult community hospital) was based on where the majority of therapy was delivered in the first three months after diagnosis. Linkage to population-based health administrative data identified additional cancer events (second cancers, relapse, death). The treatment modalities received [radiation vs. chemotherapy vs. combined modality treatment (CMT)] were compared by locus of care, as were cumulative doses of doxorubicin, bleomycin, and radiation. Predictors of CMT (vs. chemotherapy only) were examined using logistic regression. Event-free (EFS) and overall survival (OS) were determined using Kaplan-Meier methods. The impact of locus of care on EFS and OS was determined using multivariable Cox proportional hazard models, adjusting for demographic, disease, and treatment variables. Events included disease progression, relapse, death, and second malignancies. Results: Among 954 AYA with HL, 711 (74.5%) received therapy at an adult center (adult regional cancer center or community hospital). The proportion of AYA with limited stage disease did not vary between pediatric centers [90/221 (40.7%)] and adult centers [172/456 (37.7%); p=0.45]. While AYA treated at pediatric centers were more likely to receive radiation, radiation doses were higher at both adult cancer centers and adult community hospitals, as were cumulative doses of doxorubicin and bleomycin (Table 1). When adjusted for age, stage, and histology, AYA treated at pediatric centers were significantly more likely to receive CMT rather than chemotherapy alone as compared to AYA at adult cancer centers [odds ratio (OR) 5.0; 95% confidence interval (CI) 3.0-8.4; p<0.0001] or adult community hospitals (OR 3.9, CI 2.2-7.0; p<0.0001). 5-year EFS and OS for the cohort were 83.0%±1.2% and 94.9%±0.7%. 10-year EFS and OS were 81.1%±1.3% and 92.6%±7.4%. In multivariable analyses, CMT was associated with superior EFS as compared to chemotherapy alone [hazard ratio (HR) 0.68; CI 0.50-0.93; p=0.02] but was not significantly associated with OS. Despite the significant differences in treatment modality and treatment intensity between pediatric and adult centers, locus of care was not significantly associated with either EFS or OS in either univariate or multivariable analyses (Table 2). Conclusions: In this large, population-based cohort, survival outcomes did not differ between AYA treated at pediatric vs. adult centers. However, treatment intensity patterns varied, with AYA treated at a pediatric center more likely to receive radiation (though at lower doses) but exposed to lower cumulative chemotherapy doses. These results imply that acute toxicities and the types and cumulative burden of late effects may differ by locus of care. Given equivalent outcomes, these results also suggest that a proportion of AYA are being over-treated. Future analyses will study these hypotheses. Disclosures No relevant conflicts of interest to declare.

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Bortezomib-Containing Regimens (BCR) for the Treatment of Non-Transplant Eligible Multiple Myeloma

Blood ◽

10.1182/blood.v126.23.1846.1846 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1846-1846

Author(s):

Victor H Jimenez-Zepeda ◽

Peter Duggan ◽

Paola Neri ◽

Nizar J Bahlis

Keyword(s):

Overall Survival ◽

Research Funding ◽

Clinical Characteristics ◽

Progression Free Survival ◽

Categorical Variables ◽

Rank Test ◽

Cancer Center ◽

Fisher Exact Test ◽

Free Survival ◽

The Impact

Abstract Introduction In patients not eligible for transplant due to age and/or co-morbidities, the selection of up-front therapy needs to balance efficacy and toxicity. Recently, regimens with bortezomib, a proteasome inhibitor proven to be efficacious in myeloma, have been reported. Based on these findings, we aimed to evaluate the impact of different bortezomib combinations for the treatment of non transplant-eligible MM. Methods All- consecutive patients treated with bortezomib-containing regimens (BCR) at Tom Baker Cancer Center (TBCC) from 01/2006 to June/2015 were evaluated. Definitions of response and progression were used according to the EBMT modified criteria and a category of very good partial response (VGPR) was added. Two-sided Fisher exact test was used to test for differences between categorical variables. A p value of <0.05 was considered significant. Survival curves were constructed according to the Kaplan-Meier method and compared using the log rank test. Results 113 consecutive patients with MM received BCR. Thirty-three patients were treated with cyclophosphamide, bortezomib and dexamethasone (CyBorD), 41 with bortezomib, melphalan and prednisone (VMP) and 39 with bortezomib and dexamethasone (VD). Clinical characteristics are shown in Table 1. At the time of analysis, 20, 17 and 18 patients in the CyBorD, VMP and VD groups are still alive and 14, 33 and 30 have already progressed, respectively. ORR and VGPR rates were 93.9%/75.7%, 80%/53% and 76%/48% (p=0.001) for patients treated with CyBorD, VMP and VD, respectively. Median OS was NR for CyBorD, compared to 41months and 37 months for VMP and VD patients (p=0.6). Median PFS was 16.7 months for CyBorD compared to 17.5 months and 11 months for VMP and VD (P=0.6), respectively. The rate of treatment discontinuation and median number of cycles were: 9%, 26% and 12.8% and 6, 7.5 and 4 cycles for CyBorD, VMP and VD patients, respectively. Patients were to receive 6-9 cycles of treatment and the regimen could be continued to a maximum of 2 years at the discretion of the treating hematologist based on tolerability and response. Nine patients (27%) in the CyBorD group and 17 (41.4%) and 4 (10%) in the VMP and VD group received maintenance treatment. Median OS and PFS was longer for the group receiving maintenance (62 months vs 32 months and 23 months vs 10 months, p=0.007). In conclusion, bortezomib containing regimens are efficacious in the treatment of non-transplant eligible MM. Patients receiving maintenance appeared to exhibit longer PFS and OS. Very elderly patients should be subjected to frailty and comorbidity indexes aiming to decrease toxicity and prolong survival. Table 1. Clinical Characteristics Characteristic CyBorD, n=33 VMP, n=41 VD, n=39 Age (median) 58 58 58 GenderMaleFemale 20 (60.6%)13 (39.4%) 22 (53.6%)19 (46.4%) 26 (66.6%)13 (33.4%) Hb (g/L) 107 110 103 Calcium (µmol/L) 2.4 2.35 2.31 Creatinine (µmol/L) 115.5 103 108 B2microglobulin (µmol/L) 4.1 3.42 5.9 Albumin (g/L) 31 31 30 Stage IStage IIStage III 6 (12.1%)14 (42.4%)13 (45.5%) 9 (21.9%)19 (46.3%)13 (31.8%) 4 (10.2%)16 (41%)18 (48.8%) LDH (IU/L) 185 179 174 BMPC (%) 31 30 33.5 Heavy chain:IgGIgAFLC onlyIgDIgMBiclonal 2247000 19148000 21107010 Light chain:KappaLambdaBiclonal 16170 29120 24150 High riskStandard risk 5 (15%) 28 6 (14.6%)35 8 (20%)31 Ab: BMPC: Bone marrow plasma cells. Figure 1. Overall survival for patients receiving CyBorD, VMP and VD Figure 1. Overall survival for patients receiving CyBorD, VMP and VD Figure 2. Progression-Free survival for patients receiving CyBorD, VMP and VD Figure 2. Progression-Free survival for patients receiving CyBorD, VMP and VD Figure 3. OS for patients receiving CyBorD, VMP and VD maintenance Figure 3. OS for patients receiving CyBorD, VMP and VD maintenance Disclosures Jimenez-Zepeda: Celgene: Honoraria; Amgen: Honoraria; J&J: Honoraria. Duggan:Jansen: Honoraria; Celgene: Honoraria. Neri:Celgene: Research Funding. Bahlis:Johnson & Johnson: Speakers Bureau; Johnson & Johnson: Consultancy; Amgen: Consultancy; Johnson & Johnson: Research Funding; Celgene: Consultancy, Honoraria, Research Funding, Speakers Bureau.

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Clinical Characteristics and Early Treatment Patterns of Newly Diagnosed Cystic Fibrosis–Related Diabetes in Two Tertiary Centers

Diabetes ◽

10.2337/db18-2374-pub ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 2374-PUB

Author(s):

ERIN MCCORRY ◽

HIBA BASHEER ◽

JORGE E. LASCANO ◽

JOHN YOON ◽

JULIO A. LEEY

Keyword(s):

Cystic Fibrosis ◽

Early Treatment ◽

Clinical Characteristics ◽

Treatment Patterns ◽

Newly Diagnosed

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CLINICAL CHARACTERISTICS AND THE IMPACT OF VANCOMYCIN-RESISTANCE ON THE OUTCOMES IN ENTEROCOCCAL BACTEREMIA DIAGNOSED IN FEBRILE NEUTROPENIC CHILDREN

10.26226/morressier.58fa1768d462b80290b50b89 ◽

2017 ◽

Author(s):

Seung Beom Han

Keyword(s):

Clinical Characteristics ◽

Vancomycin Resistance ◽

The Impact ◽

Enterococcal Bacteremia

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How Risky Is That Risk Sharing Agreement? Mean-Variance Tradeoffs and Unintended Consequences of Six Common Risk Sharing Agreements

MDM Policy & Practice ◽

10.1177/2381468321990404 ◽

2021 ◽

Vol 6 (1) ◽

pp. 238146832199040

Author(s):

Gregory S. Zaric

Keyword(s):

Risk Sharing ◽

Financial Risk ◽

Unintended Consequences ◽

Drug Costs ◽

New Drugs ◽

Total Drug ◽

Number Of Patients ◽

Clinical Benefits ◽

The Impact ◽

Mean Variance

Background. Pharmaceutical risk sharing agreements (RSAs) are commonly used to manage uncertainties in costs and/or clinical benefits when new drugs are added to a formulary. However, existing mathematical models of RSAs ignore the impact of RSAs on clinical and financial risk. Methods. We develop a model in which the number of patients, total drug consumption per patient, and incremental health benefits per patient are uncertain at the time of the introduction of a new drug. We use the model to evaluate the impact of six common RSAs on total drug costs and total net monetary benefit (NMB). Results. We show that, relative to not having an RSA in place, each RSA reduces expected total drug costs and increases expected total NMB. Each RSA also improves two measures of risk by reducing the probability that total drug costs exceed any threshold and reducing the probability of obtaining negative NMB. However, the effects on variance in both NMB and total drug costs are mixed. In some cases, relative to not having an RSA in place, implementing an RSA can increase variability in total drug costs or total NMB. We also show that, for some RSAs, when their parameters are adjusted so that they have the same impact on expected total drug cost, they can be rank-ordered in terms of their impact on variance in drug costs. Conclusions. Although all RSAs reduce expected total drug costs and increase expected total NMB, some RSAs may actually have the undesirable effect of increasing risk. Payers and formulary managers should be aware of these mean-variance tradeoffs and the potentially unintended results of RSAs when designing and negotiating RSAs.

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Chemotherapy Delays Are Associated with Inferior Outcome in Acute Lymphoblastic Leukemia: A Retrospective Study from a Tertiary Cancer Center in South India

Indian Journal of Medical and Paediatric Oncology ◽

10.1055/s-0041-1729513 ◽

2021 ◽

Vol 42 (01) ◽

pp. 051-060

Author(s):

Vineet Agrawal ◽

Smita Kayal ◽

Prasanth Ganesan ◽

Biswajit Dubashi

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Lymphoblastic Leukemia ◽

Univariate Analysis ◽

Cancer Center ◽

Survival Outcomes ◽

Separate Analysis ◽

Term Survival ◽

Free Survival ◽

Intensive Phase ◽

The Impact

Abstract Background Treatment protocols for acute lymphoblastic leukemia (ALL) have evolved over time to give excellent cure rates in children and moderate outcomes in adults; however, little is known how delays in chemotherapy affect long-term survival. Objectives To find the association of delays during different treatment phases on the survival outcomes. Materials and Methods Data from 149 ALL cases treated between 2009 and 2015 were retrospectively analyzed. Treatment course in commonly used protocols was divided into three phases—induction, consolidation (postremission), maintenance, and also a combined intensive phase (induction plus consolidation) for the purpose of analysis, and delay in each phase was defined based on clinically acceptable breaks. Analysis was done to find the impact of treatment delay in each phase on the survival outcomes. Results The median age was 12 years (range, 1–57). Multi-center Protocol-841 (MCP-841) was used for 72%, German Multicenter Study Group for Adult ALL (GMALL) for 19%, and Berlin, Frankfurt, Muenster, 95 protocol (BFM-95) for 9% of patients. Delay in induction was seen in 52%, consolidation in 66%, and during maintenance in 42% of patients. The median follow-up was 41 months, and 3-year survival outcomes for the entire cohort were event-free survival (EFS)—60%, relapse-free survival (RFS)—72%, and overall survival (OS)—68%. On univariate analysis, delay in induction adversely affected EFS (hazard ratio [HR] = 1.78, p = 0.04), while delay in intensive phase had significantly worse EFS and RFS (HR = 2.41 [p = 0.03] and HR = 2.57 [p = 0.03], respectively). On separate analysis of MCP-841 cohort, delay in intensive phase affected both EFS (HR = 3.85, p = 0.02) and RFS (HR = 3.42, p = 0.04), whereas delay in consolidation significantly affected OS with (HR = 4.74, p = 0.04) independently. Conclusion Treatment delays mostly in intensive phase are associated with worse survival in ALL; attempts should be made to maintain protocol-defined treatment intensity while adequately managing toxicities.

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