Economic Assessment of a New Model of Care to Support Patients With Cancer Experiencing Cancer- and Treatment-Related Toxicities

2020 ◽  
Vol 16 (9) ◽  
pp. e884-e892
Author(s):  
Sophy T. F. Shih ◽  
Angela Mellerick ◽  
Georgina Akers ◽  
Kathryn Whitfield ◽  
Marj Moodie
Keyword(s):  
Cancer Care ◽  
Care Service ◽  
Economic Assessment ◽  
Additional Treatment ◽  
Model Of Care ◽  
Patients With Cancer ◽  
The Cost ◽  
Cost Offsets ◽  
The Impact ◽  
Inpatient Units

PURPOSE: The aim of this economic assessment was to evaluate the impact of a new nurse-led model of care, the Symptom and Urgent Review Clinic (SURC), for patients with cancer experiencing disease- or treatment-related symptoms. METHODS: An economic assessment was undertaken to estimate costs of the SURC from the service funder perspective and to compare the cost with cost offsets stemming from the implementation of the SURC. The cost offsets focused on the changes in emergency department (ED) presentations and inpatient admissions during a comparable 6-month period before and after the SURC implementation. Costs were analyzed in 2018 Australian dollars, and return on investment was calculated by comparing the cost offsets in the ED and inpatient units with the cost of the SURC. RESULTS: After the implementation of the SURC, patients were less likely to present to the ED (7.2% v 8.5%; P = .01), and patients who did present to the ED were more likely to be admitted to inpatient units (78% v 71%; P = .03) for additional treatment. The post-SURC period had a net cost savings of $37,090 compared with the pre-SURC period. From the service funder perspective, the SURC achieved an investment return of $1.73 for every dollar invested in the new service. CONCLUSION: Our study establishes the economic credentials of a new care model using empirical linked hospital service data. The SURC presents a new cancer care service for policy consideration from an economic standpoint. It demonstrates an efficient approach to hospital resource allocation to deliver quality cancer care.

Evolving oncology provider perspectives on care delivery during the COVID-19 pandemic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18609-e18609
Author(s):  
Divya Ahuja Parikh ◽  
Meera Vimala Ragavan ◽  
Sandy Srinivas ◽  
Sarah Garrigues ◽  
Eben Lloyd Rosenthal ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
The United States ◽  
Advanced Practice ◽  
Curative Surgery ◽  
Time Points ◽  
Patients With Cancer ◽  
Provider Perspectives ◽  
Significant Difference ◽  
The Impact

e18609 Background: The COVID-19 pandemic prompted rapid changes in cancer care delivery. We sought to examine oncology provider perspectives on clinical decisions and care delivery during the pandemic and to compare provider views early versus late in the pandemic. Methods: We invited oncology providers, including attendings, trainees and advanced practice providers, to complete a cross-sectional online survey using a variety of outreach methods including social media (Twitter), email contacts, word of mouth and provider list-serves. We surveyed providers at two time points during the pandemic when the number of COVID-19 cases was rising in the United States, early (March 2020) and late (January 2021). The survey responses were analyzed using descriptive statistics and Chi-squared tests to evaluate differences in early versus late provider responses. Results: A total of 132 providers completed the survey and most were white (n = 73/132, 55%) and younger than 49 years (n = 88/132, 67%). Respondents were attendings in medical, surgical or radiation oncology (n = 61/132, 46%), advanced practice providers (n = 48/132, 36%) and oncology fellows (n = 16/132, 12%) who predominantly practiced in an academic medical center (n = 120/132, 91%). The majority of providers agreed patients with cancer are at higher risk than other patients to be affected by COVID-19 (n = 121/132, 92%). However, there was a significant difference in the proportion of early versus late providers who thought delays in cancer care were needed. Early in the pandemic, providers were more likely to recommend delays in curative surgery or radiation for early-stage cancer (p < 0.001), delays in adjuvant chemotherapy after curative surgery (p = 0.002), or delays in surveillance imaging for metastatic cancer (p < 0.001). The majority of providers early in the pandemic responded that “reducing risk of a complication from a COVID-19 infection to patients with cancer” was the primary reason for recommending delays in care (n = 52/76, 68%). Late in the pandemic, however, providers were more likely to agree that “any practice change would have a negative impact on patient outcomes” (p = 0.003). At both time points, the majority of providers agreed with the need for other care delivery changes, including screening patients for infectious symptoms (n = 128/132, 98%) and the use of telemedicine (n = 114/132, 86%) during the pandemic. Conclusions: We found significant differences in provider perspectives of delays in cancer care early versus late in the pandemic which reflects the swiftly evolving oncology practice during the COVID-19 pandemic. Future studies are needed to determine the impact of changes in treatment and care delivery on outcomes for patients with cancer.

The HOLA COVID-19 study: Evaluating the impact of caring for patients with COVID-19 on cancer care delivery in Latin America.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1537-1537
Author(s):  
Carolina Bernabe Ramirez ◽  
Ana I. Velazquez Manana ◽  
Coral Olazagasti ◽  
Cristiane Decat Bergerot ◽  
Enrique Soto Perez De Celis ◽  
...  
Keyword(s):  
Latin America ◽  
Latin American ◽  
Cancer Care ◽  
Online Survey ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Significant Proportion ◽  
Multiple Choice Questions ◽  
Patients With Cancer ◽  
The Impact

1537 Background: The severe acute respiratory syndrome 2 (SARS-cov-2) virus causing COVID-19 has brought great challenges to global health services affecting cancer care delivery, outcomes, and increasing the burden in oncology providers (OP). Our study aimed to describe the challenges that OP faced while delivering cancer care in Latin America. Methods: We conducted an international cross-sectional study using an anonymous online survey in Spanish, Portuguese, and English. The questionnaire included 43 multiple choice questions. The sample was stratified by OP who have treated patients with COVID-19 versus those who have not treated patients with COVID-19. Data was analyzed with descriptive statistics and Chi-square tests. Results: A total of 704 OP from 20 Latin American countries completed the survey (77% of 913 who started the survey). Oncologists represented 46% of respondents, followed by 25% surgical-oncologists. Of the respondents, 56% treated patients with COVID-19. A significant proportion of OP reported newly adopting telemedicine during COVID-19 (14% vs 72%, p=0.001). More than half (58%) of OP reported making changes to the treatments they offered to patients with cancer. As shown in the table, caring for patients with COVID-19 significantly influenced practice patterns of OP. Access to specialty services and procedures was significantly reduced: 40% noted significantly decreased or no access to imaging, 20% significantly decreased or no access to biopsies, 65% reported delays in surgical oncology referrals, and 49% in radiation oncology referrals. A vast majority (82%) reported oncologic surgeries were delayed or cancelled, which was heightened among those treating patients with COVID-19 (87% vs 77%, p=0.001). Conclusions: The COVID-19 pandemic has significantly affected the way cancer care is delivered in globally. Although changes to healthcare delivery are necessary as a response to this global crisis, our study highlights the significant disruption and possible undertreatment of patients with cancer in Latin America that results from COVID-19.[Table: see text]

scholarly journals The Impact of New Drug Launches on Hospitalization in 2015 for 67 Medical Conditions in 15 OECD Countries: A Two-Way Fixed-Effects Analysis

2018 ◽  
Vol 21 (2) ◽  
Author(s):  
Frank R. Lichtenberg
Keyword(s):  
Prescription Drug ◽  
Fixed Effects ◽  
Medical Costs ◽  
Oecd Countries ◽  
Pharmaceutical Innovation ◽  
Cost Offset ◽  
The Cost ◽  
Cost Offsets ◽  
The Impact ◽  
Over Time

Abstract There are two types of prescription drug cost offsets. The first type of cost offset – from prescription drug use – is primarily about the effect of changes in drug quantity (e.g. due to changes in out-of-pocket drug costs) on other medical costs. Previous studies indicate that the cost offsets from prescription drug use may slightly exceed the cost of the drugs themselves. The second type of cost offset – the cost offset from prescription drug innovation – is primarily about the effect of prescription drug quality on other medical costs. Two previous studies (of a single disease or a single country) found that pharmaceutical innovation reduced hospitalization, and that the reduction in hospital cost from the use of newer drugs was considerably greater than the innovation-induced increase in pharmaceutical expenditure. In this study, we reexamine the impact that pharmaceutical innovation has had on hospitalization, employing a different type of 2-way fixed effects research design. In lieu of analyzing different countries over time for a single disease, or different diseases over time for a single country, we estimate the impact that new drug launches that occurred during the period 1982–2015 had on hospitalization in 2015 for 67 diseases in 15 OECD countries. Our models include both country fixed effects and disease fixed effects, which control for the average propensity of people to be hospitalized in each country and from each disease. The number of hospital discharges and days of care in 2015 is significantly inversely related to the number of drugs launched during 1982–2005, but not significantly related to the number of drugs launched after 2005. (Utilization of drugs during the first few years after they are launched is relatively low, and drugs for chronic conditions may have to be consumed for several years to achieve full effectiveness.) The estimates imply that, if no new drugs had been launched after 1981, total days of care in 2015 would have been 163% higher than it actually was. The estimated reduction in 2015 hospital expenditure that may be attributable to post-1981 drug launches was 5.3 times as large as 2015 expenditure on those drugs.

Environmental and Economic Assessment of Recycled Aluminum Alloy Production - A Case Study of China

2010 ◽  
Vol 146-147 ◽  
pp. 1027-1030
Author(s):  
Jing Min Hong ◽  
Zainab Z. Ismail ◽  
Jing Lan Hong
Keyword(s):  
Aluminum Alloy ◽  
Economic Impacts ◽  
Economic Assessment ◽  
High Energy ◽  
Electricity Production ◽  
Aluminum Scrap ◽  
Terrestrial Ecotoxicity ◽  
Production Stages ◽  
The Cost ◽  
The Impact

A life cycle assessment was carried out to estimate the environmental and economic impacts of recycled aluminum alloy production. The impact seen from non-carcinogens, respiratory inorganics, terrestrial ecotoxicity, global warming and non-renewable energy categories played an important role to overall environmental impacts. The impact seen from carcinogens and aquatic ecotoxicity played relatively small role, while the impact seen from the rest categories affect the environment was ignorable. Specifically, the emissions from the aluminum and silicon production stages involved played an important role due to high energy consumption, while potential impact generated from other elements was quite small. Similarly, the cost of old aluminum scrap represented the dominant contribution to overall economic impacts. Accordingly, choosing natural gas based electricity production technology and improving old aluminum scrap consumption efficiency are the efficient way to minimize the overall environmental and economic impact, respectively.

scholarly journals Do Patients and Oncologists Discuss the Cost of Cancer Treatment? An Observational Study of Clinical Interactions Between African American Patients and Their Oncologists

2017 ◽  
Vol 13 (3) ◽  
pp. e249-e258 ◽  
Author(s):  
Lauren M. Hamel ◽  
Louis A. Penner ◽  
Susan Eggly ◽  
Robert Chapman ◽  
Justin F. Klamerus ◽  
...  
Keyword(s):  
Social Support ◽  
African American ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Financial Toxicity ◽  
Younger Patients ◽  
Patients With Cancer ◽  
The Cost ◽  
Clinical Interactions ◽  
The Impact

Purpose: Financial toxicity negatively affects patients with cancer, especially racial/ethnic minorities. Patient-oncologist discussions about treatment-related costs may reduce financial toxicity by factoring costs into treatment decisions. This study investigated the frequency and nature of cost discussions during clinical interactions between African American patients and oncologists and examined whether cost discussions were affected by patient sociodemographic characteristics and social support, a known buffer to perceived financial stress. Methods Video recorded patient-oncologist clinical interactions (n = 103) from outpatient clinics of two urban cancer hospitals (including a National Cancer Institute–designated comprehensive cancer center) were analyzed. Coders studied the videos for the presence and duration of cost discussions and then determined the initiator, topic, oncologist response to the patient’s concerns, and the patient’s reaction to the oncologist’s response. Results: Cost discussions occurred in 45% of clinical interactions. Patients initiated 63% of discussions; oncologists initiated 36%. The most frequent topics were concern about time off from work for treatment (initiated by patients) and insurance (initiated by oncologists). Younger patients and patients with more perceived social support satisfaction were more likely to discuss cost. Patient age interacted with amount of social support to affect frequency of cost discussions within interactions. Younger patients with more social support had more cost discussions; older patients with more social support had fewer cost discussions. Conclusion: Cost discussions occurred in fewer than one half of the interactions and most commonly focused on the impact of the diagnosis on patients’ opportunity costs rather than treatment costs. Implications for ASCO’s Value Framework and design of interventions to improve cost discussions are discussed.

Communicating the Financial Burden of Treatment With Patients

2018 ◽  
pp. 524-531 ◽  
Author(s):  
Ryan D. Nipp ◽  
Ellen Miller Sonet ◽  
Gery P. Guy
Keyword(s):  
Cancer Care ◽  
Psychological Symptoms ◽  
Financial Burden ◽  
Patients With Cancer ◽  
Burden Of Treatment ◽  
The Cost ◽  
Care Costs ◽  
Financial Burden Of Cancer ◽  
Patient Concerns

In recent years, high health care costs and the financial burden of cancer care have received increased attention. In response to the financial burden of cancer care, patients may jeopardize their health outcomes by not properly adhering to prescribed therapies or even forgoing and delaying care in an effort to defray costs. In addition, the financial burden experienced by patients with cancer may negatively impact clinical outcomes, such as quality of life, physical and psychological symptoms, and potentially, even survival. Notably, in the current era of targeted treatment and immunotherapies for patients with cancer, the rising costs of cancer continue to remain at the forefront of patient concerns. Therefore, a critical need exists to determine how best to assist patients with the cost burden of cancer diagnosis and treatment

Demonstrating the impact and model of care of a Statewide psychiatric intensive care service

2013 ◽  
Vol 21 (5) ◽  
pp. 466-471 ◽  
Author(s):  
Stuart Lee ◽  
Yitzchak Hollander ◽  
Lisa Scarff ◽  
Ryan Dube ◽  
Sandra Keppich-Arnold ◽  
...  
Keyword(s):  
Intensive Care ◽  
Care Service ◽  
Model Of Care ◽  
The Impact

scholarly journals Antibacterial coating of implants: are we missing something?

2019 ◽  
Vol 8 (5) ◽  
pp. 199-206 ◽  
Author(s):  
C. L. Romanò ◽  
H. Tsuchiya ◽  
I. Morelli ◽  
A. G. Battaglia ◽  
L. Drago
Keyword(s):  
Large Scale ◽  
Hospital Costs ◽  
Economic Assessment ◽  
Regulatory Pathways ◽  
Surgical Infection ◽  
Antibacterial Coating ◽  
Antibacterial Coatings ◽  
Preclinical And Clinical Studies ◽  
The Cost ◽  
The Impact

Implant-related infection is one of the leading reasons for failure in orthopaedics and trauma, and results in high social and economic costs. Various antibacterial coating technologies have proven to be safe and effective both in preclinical and clinical studies, with post-surgical implant-related infections reduced by 90% in some cases, depending on the type of coating and experimental setup used. Economic assessment may enable the cost-to-benefit profile of any given antibacterial coating to be defined, based on the expected infection rate with and without the coating, the cost of the infection management, and the cost of the coating. After reviewing the latest evidence on the available antibacterial coatings, we quantified the impact caused by delaying their large-scale application. Considering only joint arthroplasties, our calculations indicated that for an antibacterial coating, with a final user’s cost price of €600 and able to reduce post-surgical infection by 80%, each year of delay to its large-scale application would cause an estimated 35 200 new cases of post-surgical infection in Europe, equating to additional hospital costs of approximately €440 million per year. An adequate reimbursement policy for antibacterial coatings may benefit patients, healthcare systems, and related research, as could faster and more affordable regulatory pathways for the technologies still in the pipeline. This could significantly reduce the social and economic burden of implant-related infections in orthopaedics and trauma.Cite this article: C. L. Romanò, H. Tsuchiya, I. Morelli, A. G. Battaglia, L. Drago. Antibacterial coating of implants: are we missing something? Bone Joint Res 2019;8:199–206. DOI: 10.1302/2046-3758.85.BJR-2018-0316.

scholarly journals What Happens when the Cost of Cancer Care Becomes Unsustainable?

2017 ◽  
Vol 13 (02) ◽  
pp. 108 ◽  
Author(s):  
Steven Simoens ◽  
Wim van Harten ◽  
Gilberto Lopes ◽  
Arnold Vulto ◽  
Klaus Meier ◽  
...  
Keyword(s):  
Cancer Care ◽  
Decision Makers ◽  
Incremental Innovation ◽  
Cancer Drugs ◽  
Cancer Treatments ◽  
Access To Treatment ◽  
Scarce Resources ◽  
Patients With Cancer ◽  
Heavy Burden ◽  
The Cost

Cancer places a heavy burden on healthcare systems. The cost of cancer drugs is increasing, driven largely by the introduction of new, ever more innovative cancer treatments. This raises questions about value for money and the future sustainability of cancer care, and presents significant challenges for decision-makers in providing all patients with access to treatments and effective new cancer medicines. The aims of this article are to provide an understanding of how sustainability in cancer care is defined, what signs indicate that the limits of sustainability are being reached, and what potential impact this may have on patients with cancer within Europe. Each country is faced with making difficult decisions about the allocation of healthcare resources to cancer care, to best meet the health needs of their patients. Determining the value of individual cancer drugs can help to inform these decisions, because premium pricing for incremental innovation is no longer sustainable. When the cost of cancer care becomes unsustainable, countries may be forced to restrict health expenditure by limiting demand, cutting spending and reducing investment. This can lead to restricted access to treatment. New, innovative cancer treatments must provide greater value than current options, and measures are needed to contain and reduce expenditure and make best use of scarce resources, without impeding access to effective and safe treatments for all patients.

Psychosocial impacts of the COVID-19 pandemic on young adult cancer survivors and parents of children with cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10050-10050
Author(s):  
Stephanie M Smith ◽  
Dhanya Kumar ◽  
Catherine Benedict ◽  
Lauren C. Heathcote ◽  
Catherine Aftandilian ◽  
...  
Keyword(s):  
Young Adult ◽  
Perceived Stress ◽  
Pediatric Oncology ◽  
Cancer Care ◽  
Care Service ◽  
Related Factors ◽  
Young Adult Cancer Survivors ◽  
Adult Cancer Survivors ◽  
The Impact ◽  
Hispanic White

10050 Background: The COVID-19 pandemic has affected oncology practice in a variety of ways. We sought to evaluate the impact on pediatric oncology parent and young adult (YA) patient experiences, concerns, and perceived stress. Methods: We conducted a cross-sectional Internet-based survey of parents and YA patients in the pediatric oncology and survivorship clinics at Stanford between June-December 2020. Patients were recruited in person by clinic staff or through the electronic patient health portal. Surveys (available in English and Spanish) included the NIH Perceived Stress Scale (PSS-10) and investigator-developed questions evaluating clinical practice changes, concerns about health and cancer care, and pandemic-related challenges. Bivariate analyses evaluated associations between demographic, clinical, and pandemic-related factors and (a) concern about the pandemic affecting health and cancer care, and (b) perceived stress. Results: Among 81 participants (66 parents, mean age 41.6 ± SD 9.6; 15 YAs, mean age 21.9 ± 8.4 years), 37% self-identified as Hispanic/Latino, 36% non-Hispanic white, and 21% Asian. Twenty-eight percent were on treatment and 47% had completed treatment (79% < 5 years prior). Thirty percent reported cancer-related appointment changes, largely rescheduling (75%) and/or switching to telehealth (42%). Nearly half (45%) of parents and 27% of YAs reported feeling ‘very’ or ‘extremely’ concerned about the pandemic affecting their child’s/their health or cancer care. Race/ethnicity emerged as the only demographic feature that was significantly associated with high concern (p = 0.018), with 57% of Hispanic/Latino and only 21% of non-Hispanic white respondents reporting high levels of concern. Specific concerns included fear of severe infection, immunosuppression, and whether infection would change treatment and compromise effectiveness. Parents and YAs reported ‘a lot’ or ‘a great deal’ of challenges in their personal/family life (61%) and work/professional life (48%). Among these were having less support from friends/family (35%), reduced wages/work hours (31%), and job loss (20%) with 20% reporting ≥ 3 challenges. On the PSS-10, stress in the past month was high for parents (mean 30 ± 4) and YAs (mean 31 ± 5.1) on a scale of 0-40. Risk factors for higher stress included: male gender (p = 0.028), less support from family/friends (p = 0.002), and experiencing ≥ 3 pandemic-related challenges (p = 0.013). Conclusions: Our findings confirm the prevalent worry and stress that pediatric oncology patients and families are experiencing during the COVID-19 pandemic. Better communication about cancer care service changes may help to alleviate some concerns. Supportive care resources may also help patients and families cope with psychosocial stressors, particularly among at-risk groups.

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