Socioeconomic Consequences of Cervical Cancer: A Narrative Review

2020 ◽  
Vol 16 (3) ◽  
pp. 194-200
Author(s):  
Mansoureh Refaei ◽  
Soodabeh Aghababaei ◽  
Mansoureh Yazdkhasti
Keyword(s):  
Cervical Cancer ◽  
Indirect Costs ◽  
Direct Costs ◽  
Narrative Review ◽  
Economic Consequences ◽  
Invasive Treatment ◽  
Hospitalization Costs ◽  
Choice Of Treatment ◽  
Socioeconomic Consequences ◽  
The Impact

Background: Cervical cancer affects women in the time that they are critical to economic and social stability. Objective: The aim of this narrative review to assess the socio-economic consequences of cervical cancer. Methods: In this review, Pubmed, Scopus, ISI web of science, Conferences databases and Iranian databases were searched. In order to search related articles, researchers used the following terms: “Uterine cervical neoplasms” OR ‘cervical cancer”; Costs and cost analysis; costs of illness, burden, socioeconomic. After the primary search, some records were obtained from 1960 to 2018. After studying titles, abstracts, and in some cases the full texts, 48 relevant articles were included in this research. Results: Hospitalization costs were the highest direct costs. However, total social costs are higher than health and medical costs. There is a dramatic increase in direct costs with the increase in age and stage of the disease. The costs are less for people aged 75 and up and for stage 4 because of less invasive treatment received by older women and the limited choice of treatment in advanced stages. The costs for persons who were screened 6 months to 5 years before diagnosis were lower. Conclusion: The burden of the disease is high. Early detection of cancer can save lives and reduce health care costs. Studies evaluating the costs associated with cervical cancer as well as virusrelated diseases in developing countries, calculating indirect costs and the impact of the disease on family members, relatives, and especially the spouse of the affected women are recommended.

scholarly journals POS0530 HOW DOES MULTIMORBIDITY IMPACT ON THE DIRECT AND INDIRECT COSTS IN PATIENTS WITH RHEUMATOID ARTHRITIS?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 498.3-499
Author(s):  
P. H. Hsieh ◽  
C. Geue ◽  
O. Wu ◽  
E. McIntosh
Keyword(s):  
Rheumatoid Arthritis ◽  
Early Rheumatoid Arthritis ◽  
Employment Status ◽  
Functional Disability ◽  
Hospital Admissions ◽  
Information Service ◽  
Indirect Costs ◽  
Direct Costs ◽  
Direct And Indirect Costs ◽  
The Impact

Background:Comorbidities are prevalent in patients with rheumatoid arthritis (RA) and associated with worse outcomes as well as higher economic burden. Little is known about the impact of multimorbidity on the direct and indirect costs of RA. Evidence of the incremental scale of these multimorbidity costs will usefully inform RA interventions and policies.Objectives:The aim of this study was to describe how multimorbidity impacts on the cost-of-illness, including direct and indirect costs, in patients with RA.Methods:The Scottish Early Rheumatoid Arthritis (SERA) is a registry of patients newly presenting with RA since 2011. It contains data on patient characteristics, clinical outcomes, health-related quality of life, and employment status data. These data were linked to routinely recorded hospital admissions and primary care prescribing data. Direct costs were estimated by applying relevant unit costs to healthcare resource use quantities. Indirect cost estimates were obtained from information on employment status and hospital admissions, valued by age and sex specific wages. Two-part models (probit followed by generalized linear model) were used to estimate direct and indirect costs, adjusting for age, gender, and functional disability. The Charlson Comorbidity Index (CCI) score was calculated using patient ICD-10 diagnoses from hospital records. The number of comorbidities was categorized into “RA alone”, “single comorbidity” and “multimorbidity (>1 comorbidity)”.Results:Data were available for 1,150 patients, 65.7% were female and a mean age of 57.5±14 years. The majority of patients only had RA (54.1%), followed by a single comorbidity (23.4%) and multimorbidity (22.5%). Annual total costs were significantly higher for patients with multimorbidity (£6,669 95% CI £4,871-£8,466; OR 11.3 95% CI 8.14-15.87) and for patients with a single comorbidity (£2,075 95% CI £1,559-£2,591; OR 3.52 95% CI 2.61-4.79), when compared with RA alone (£590). The excess costs were mainly driven by direct costs (£6,281 versus £1,875 versus £556). Although the difference in indirect costs between patients with multimorbidity and a single comorbidity were not statistically significant (£1,218 versus £914, p=0.11), patients with multimorbidity were associated with significantly higher costs than those with RA only (£594, p<0.01).Conclusion:The presence of comorbidity contributes significant excess to both direct and indirect costs among RA patients. In particular, patients with multimorbidity incurred substantially higher direct costs than those with a single comorbidity or RA only.Acknowledgements:The study analysed the data from the Scottish Early Rheumatoid Arthritis (SERA) study with a linkage to routinely recorded health data from Information Service Division, National Service Scotland. We would like to thank all the patients, clinical and nursing colleagues who have contributed their time and support to the study, the SERA steering committee for the approval, and Allen Tervit from the Robertson Centre for Biostatistics, University of Glasgow for the timely technical supports.Disclosure of Interests:Ping-Hsuan Hsieh: None declared, Claudia Geue: None declared, Olivia Wu Consultant of: OW has received consultancy fees from Bayer, Lupin and Takeda outside the submitted work., Emma McIntosh: None declared

scholarly journals How Much do Needlestick Injuries Cost? A Systematic Review of the Economic Evaluations of Needlestick and Sharps Injuries Among Healthcare Personnel

2016 ◽  
Vol 37 (6) ◽  
pp. 635-646 ◽  
Author(s):  
Alice Mannocci ◽  
Gabriella De Carli ◽  
Virginia Di Bari ◽  
Rosella Saulle ◽  
Brigid Unim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Indirect Costs ◽  
Occupational Exposures ◽  
Direct Costs ◽  
Data Driven ◽  
Healthcare Personnel ◽  
Economic Evaluations ◽  
Modeling Studies ◽  
Intangible Costs ◽  
The Impact

OBJECTIVETo provide an overview of the economic aspects of needlestick and sharps injury (NSI) management among healthcare personnel (HCP) within a Health Technology Assessment project to evaluate the impact of safety-engineered devices on health careMETHODSA systematic review of economic analyses related to NSIs was performed in accordance with the PRISMA statement and by searching PubMed and Scopus databases (January 1997–February 2015). Mean costs were stratified by study approach (modeling or data driven) and type of cost (direct or indirect). Costs were evaluated using the CDC operative definition and converted to 2015 International US dollars (Int$).RESULTSA total of 14 studies were retrieved: 8 data-driven studies and 6 modeling studies. Among them, 11 studies provided direct and indirect costs and 3 studies provided only direct costs. The median of the means for aggregate (direct + indirect) costs was Int$747 (range, Int$199–Int$1,691). The medians of the means for disaggregated costs were Int$425 (range, Int$48–Int$1,516) for direct costs (9 studies) and Int$322 (range, Int$152–Int$413) for indirect costs (6 studies). When compared with data-driven studies, modeling studies had higher disaggregated and aggregated costs, but data-driven studies showed greater variability. Indirect costs were consistent between studies, mostly referring to lost productivity, while direct costs varied widely within and between studies according to source infectivity, HCP susceptibility, and post-exposure diagnostic and prophylactic protocols. Costs of treating infections were not included, and intangible costs could equal those associated with NSI medical evaluations.CONCLUSIONSNSIs generate significant direct, indirect, potential, and intangible costs, possibly increasing over time. Economic efforts directed at preventing occupational exposures and infections, including provision of safety-engineered devices, may be offset by the savings from a lower incidence of NSIs.Infect Control Hosp Epidemiol 2016;37:635–646

scholarly journals The impact of asthma in Brazil: a longitudinal analysis of data from a Brazilian national database system

2017 ◽  
Vol 43 (3) ◽  
pp. 163-168 ◽  
Author(s):  
Thiago de Araujo Cardoso ◽  
Cristian Roncada ◽  
Emerson Rodrigues da Silva ◽  
Leonardo Araujo Pinto ◽  
Marcus Herbert Jones ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Admissions ◽  
Indirect Costs ◽  
Mortality Rates ◽  
Absolute Number ◽  
Public Health Care ◽  
National Database ◽  
Hospitalization Costs ◽  
The Absolute ◽  
The Impact

ABSTRACT Objective: To present official longitudinal data on the impact of asthma in Brazil between 2008 and 2013. Methods: This was a descriptive study of data collected between 2008 and 2013 from an official Brazilian national database, including data on asthma-related number of hospitalizations, mortality, and hospitalization costs. A geographical subanalysis was also performed. Results: In 2013, 2,047 people died from asthma in Brazil (5 deaths/day), with more than 120,000 asthma-related hospitalizations. During the whole study period, the absolute number of asthma-related deaths and of hospitalizations decreased by 10% and 36%, respectively. However, the in-hospital mortality rate increased by approximately 25% in that period. The geographic subanalysis showed that the northern/northeastern and southeastern regions had the highest asthma-related hospitalization and in-hospital mortality rates, respectively. An analysis of the states representative of the regions of Brazil revealed discrepancies between the numbers of asthma-related hospitalizations and asthma-related in-hospital mortality rates. During the study period, the cost of asthma-related hospitalizations to the public health care system was US$ 170 million. Conclusions: Although the numbers of asthma-related deaths and hospital admissions in Brazil have been decreasing since 2009, the absolute numbers are still high, resulting in elevated direct and indirect costs for the society. This shows the relevance of the burden of asthma in middle-income countries.

scholarly journals Economic burden of schizophrenia in Italy: a probabilistic cost of illness analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018359 ◽  
Author(s):  
Andrea Marcellusi ◽  
Gianluca Fabiano ◽  
Raffaella Viti ◽  
Pier Cesare Francesa Morel ◽  
Giuseppe Nicolò ◽  
...  
Keyword(s):  
Cost Of Illness ◽  
Economic Burden ◽  
Indirect Costs ◽  
Direct Costs ◽  
Psychiatric Disease ◽  
Resource Utilisation ◽  
Treatment Pathways ◽  
Specialist Services ◽  
Illness Model ◽  
The Impact

ObjectivesSchizophrenia is a chronic, debilitating psychiatric disease with highly variable treatment pathways and consequent economic impacts on resource utilisation. The aim of the study was to estimate the economic burden of schizophrenia in Italy for both the societal and Italian National Healthcare perspective.MethodsA probabilistic cost of illness model was applied. A systematic literature review was carried out to identify epidemiological and economic data. Direct costs were calculated in terms of drugs, hospitalisations, specialist services, residential and semiresidential facilities. Indirect costs were calculated on the basis of patients’ and caregivers’ loss of productivity. In addition, the impact of disability compensation was taken into account using a database from the Italian National Social Security Institute —Italy (INPS).ResultsOverall, 303 913 prevalent patients with schizophrenia were estimated. Of these, 212 739 (70%) were diagnosed and 175 382 (82%) were treated with antipsychotics. The total economic burden was estimated at €2.7 billion (95% CI €1771.93 to €3988.65), 50.5% due to indirect costs and 49.5% to direct costs. Drugs corresponded to 10% of direct costs and hospitalisations (including residential and semiresidential facilities) accounted for 81%.ConclusionsThis study highlighted that indirect costs and hospitalisations (including residential and semiresidential facilities) play a major role within the expenses associated with schizophrenia in Italy, and this may be considered as a tool for public decision-makers.

Burden of Illness of FLT-3 Mutated Acute Myeloid Leukemia (AML)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4765-4765
Author(s):  
Michelle L Sotak ◽  
Mihaela Marin ◽  
John Coombs ◽  
Gary J. Schiller ◽  
April Teitelbaum
Keyword(s):  
Stem Cell ◽  
Research Funding ◽  
Burden Of Illness ◽  
Survival Rates ◽  
Indirect Costs ◽  
Direct Costs ◽  
Wild Type ◽  
Cell Transplants ◽  
Stem Cell Transplants ◽  
The Impact

Abstract Abstract 4765 Introduction: Patients with FLT3-mutated AML have poor prognoses due to shorter survival, a high incidence of relapse, and a lack of effective treatment options. Limited information is published on the burden of illness (BOI) of AML, especially for patients with FLT3-mutated disease. This study reviewed the epidemiologic, clinical, humanistic, and economic literature and estimated the burden of FLT3-mutated AML in the US. Methods: A systematic literature review was conducted in PubMed to identify clinical and economic publications on AML published in English from 2000 to 2011. Data relevant to the burden of FLT3-mutated AML were abstracted. 607 citations were identified in PubMed. 581 abstracts were screened and 35 articles were abstracted. Epidemiologic data were also sought from the Surveillance, Epidemiology and End Results (SEER) database. Areas where information was limited or not available were identified and discussed with clinicians experienced in treating AML. An Excel model was then developed to estimate the population-level BOI of AML by FLT3 status. Resource utilization estimates were obtained from the literature and expert opinion. Direct costs included procedures, hospitalizations, outpatient/office visits, other resource use (home health care, hospice, skilled nursing facility), and medications (including chemotherapy). Indirect costs included lost productivity but did not include costs associated with premature retirement or premature mortality. Results: In patients age <60 years, the literature reported FLT3 mutations in up to 30% of AML cases. Patients with FLT3-mutated AML have poorer prognoses: per the literature, median overall survival estimates of 15.2–15.5 months for FLT3-mutated AML patients <60 years of age was noted compared to 19.3–28.6 months for wild-type AML patients. Five-year survival rates for age <60 years range from 15% for high ITD-mutant levels to 31% in low ITD mutant-levels for FLT3-mutated AML patients vs. 42% for wild-type AML patients. No studies were identified containing estimates for the incidence or prevalence of FLT-3 mutated AML. The prevalence of AML in 2008 was obtained from SEER data and was estimated at 27,813 patients aged ≥20 years. Age- and gender-specific incidence and relative 5-year survival rates were obtained from SEER data. Projections for the prevalence, incidence, and mortality of FLT3-mutated AML through 2020 were calculated based on the SEER estimates, age- and gender-specific US Census population projections, and an assumption of FLT3 mutations in 23% of AML cases. In 2010, it was estimated that 725 patients aged 20–60 years were diagnosed with FLT3-mutated AML, with 572 disease-related deaths. Three studies were identified which reported information on the impact of AML on quality of life (QoL), though none described the QoL impact of FLT-3 mutated AML. One study specifically examined the <60 year old population, noting that AML patients receiving stem cell transplants had significantly worse long-term impact on QoL vs. patients receiving conventional chemotherapy. No studies quantifying the impact of AML on productivity were identified. In our analysis, the overall economic burden of FLT-3 mutated AML in the US was estimated at $244 million in 2010, including $184 million in direct costs and $60 million in indirect costs from lost productivity. Stem cell transplants accounted for 21% of direct costs, inpatient hospitalizations accounted for 44%, and medications for 4%. For AML patients <60 years, the overall cost per newly diagnosed FLT3-mutated AML patient was estimated at $114,198 vs. $105,825 for newly diagnosed FLT3-wild-type AML patients. This is likely an underestimate of the cost as the impacts of early mortality and early retirement were not included in the indirect costs. In addition, the impact of QoL was not included and this may also underestimate costs due to more frequent use of transplantation in the FLT3-mutated AML population. Conclusions: AML poses a large economic burden, both for the healthcare system and society. FLT3-mutated AML potentially represents a greater per-patient burden than FLT3 wild type AML due to shorter survival rates and use of more costly therapies such as stem cell transplants. Investigational treatments targeting the FLT3 mutation may provide an additional therapeutic option for these patients and have the potential to improve clinical outcomes. Disclosures: Sotak: Novartis: Research Funding. Marin:Novartis: Research Funding. Coombs:Novartis: Employment. Schiller:BMS: Research Funding; Celgene: Research Funding; Ambit: Research Funding; Novartis: Research Funding; Sunesis: Research Funding. Teitelbaum:Novartis: Research Funding.

scholarly journals The excess costs of childhood food allergy on Canadian families: a cross-sectional study

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Michael A. Golding ◽  
Elinor Simons ◽  
Elissa M. Abrams ◽  
Jennifer Gerdts ◽  
Jennifer L. P. Protudjer
Keyword(s):  
Food Allergy ◽  
Indirect Costs ◽  
Cross Sectional Study ◽  
Direct Costs ◽  
Median Income ◽  
Cross Sectional ◽  
Pediatric Allergy ◽  
Allergic Child ◽  
Household Costs ◽  
The Impact

Abstract Background The impact of childhood food allergy on household costs has not been examined in Canada. The current study sought to examine differences in direct, indirect, and intangible costs among Canadian families with and without a food-allergic child. Methods Families with a child with a specialist-diagnosed food allergy (cases) were recruited from two tertiary pediatric allergy clinics in the Province of Manitoba, Canada, and matched, based on age and sex, to families without a food-allergic child (controls). Cost data for the two groups were collected via an adapted version of the Food Allergy Economic Questionnaire (FA-EcoQ). Consideration was given to income, defined as above vs. below the provincial annual median income. Results Results from 35 matched case/control pairs revealed that while total household costs did not significantly differ between cases and controls, food-allergic families did incur higher direct costs ($12,455.69 vs. $10,078.93, p = 0.02), which were largely attributed to spending on food. In contrast, cases reported lower, but not statistically significant, total indirect costs compared to controls ($10,038.76 vs. $12,294.12, p = 0.06). Families also perceived their food-allergic child as having poorer quality of life relative to their healthy peers. Lastly, stratification of the analyses by annual income revealed several differences between the higher and lower income groups. Conclusions Relative to families without a food-allergic child, food-allergic families incurred higher direct costs across a number of different areas.

scholarly journals The societal costs of problem gambling in Sweden

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
T. Hofmarcher ◽  
U. Romild ◽  
J. Spångberg ◽  
U. Persson ◽  
A. Håkansson
Keyword(s):  
Public Health ◽  
Alcohol Consumption ◽  
Problem Gambling ◽  
Indirect Costs ◽  
Direct Costs ◽  
Economic Consequences ◽  
Public Health Issue ◽  
Societal Costs ◽  
Prevention And Treatment ◽  
Intangible Costs

Abstract Background Problem gambling is a public health issue affecting both the gamblers, their families, their employers, and society as a whole. Recent law changes in Sweden oblige local and regional health authorities to invest more in prevention and treatment of problem gambling. The economic consequences of gambling, and thereby the potential economic consequences of policy changes in the area, are unknown, as the cost of problem gambling to society has remained largely unexplored in Sweden and similar settings. Methods A prevalence-based cost-of-illness study for Sweden for the year 2018 was conducted. A societal approach was chosen in order to include direct costs (such as health care and legal costs), indirect costs (such as lost productivity due to unemployment), and intangible costs (such as reduced quality of life due to emotional distress). Costs were estimated by combining epidemiological and unit cost data. Results The societal costs of problem gambling amounted to 1.42 billion euros in 2018, corresponding to 0.30% of the gross domestic product. Direct costs accounted only for 13% of the total costs. Indirect costs accounted for more than half (59%) of the total costs, while intangible costs accounted for 28%. The societal costs were more than twice as high as the tax revenue from gambling in 2018. Direct and indirect costs of problem gambling combined amounted to one third of the equivalent costs of smoking and one sixth of the costs of alcohol consumption in Sweden. Conclusions Problem gambling is increasingly recognized as a public health issue. The societal costs of it are not negligible, also in relation to major public health issues of an addictive nature such as smoking and alcohol consumption. Direct costs for prevention and treatment are very low. A stronger focus on prevention and treatment might help to reduce many of the very high indirect and intangible costs in the future.

Economic burden associated with cervical cancer: An analysis of patient-reported outcomes in the United States.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17021-e17021
Author(s):  
Chizoba Nwankwo ◽  
Nate Alexander Way ◽  
Vicky Weitian Li
Keyword(s):  
Cervical Cancer ◽  
Economic Burden ◽  
Patient Reported Outcomes ◽  
Multivariable Analysis ◽  
The United States ◽  
Direct Costs ◽  
Medical Expenditure ◽  
Patient Reported ◽  
Hospitalization Costs ◽  
The Difference

e17021 Background: Although much is known about the prevention, screening, and treatment of cervical cancer (CC), less is known about its economic burden. This study compared patient-reported outcomes (PROs) between women diagnosed and treated for CC, women diagnosed and untreated for CC, and women without CC. Methods: Data were aggregated from the 2013-2015 US National Health and Wellness Surveys, a nationally-representative, self-administered, internet-based survey of adults (N = 269,447). Controlling for baseline patient demographics and characteristics, three matched cohorts were compared in multivariable analysis: treated CC, untreated CC, and no CC. Treated CC and untreated CC patients with other forms of comorbid cancer were excluded from analyses. Economic outcomes included healthcare resource use (HCRU) over the past six months and annualized direct costs. Direct costs were calculated using Medical Expenditure Panel Survey data. Results: Adjusted means are reported. Treated CC (N = 192), untreated CC (N = 829), and no CC (N = 1,018) cohorts largely differed by number of healthcare provider (HCP) visits (0.95 vs. 0.89 vs. 0.84, p’s < 0.05), hospitalizations (0.18 vs. 0.09 vs. 0.10, p’s < 0.05), and ER visits (0.29 vs. 0.19 vs. 0.16, p’s < 0.05), though the difference between untreated CC and no CC cohorts was not significant for hospitalizations nor ER visits. Treated CC, untreated CC, and no CC cohorts also largely differed by HCP costs ($14,143 vs. $11,187 vs. $10,573, p’s < 0.01), hospitalization costs ($12,006 vs. $4,202 vs. $4,908, p’s < 0.01), ER costs ($2,104 vs. $995 vs. $872, p’s < 0.01), and total direct costs ($30,768 vs. $16,613 vs. $16,776, p’s < 0.01), though the difference between untreated CC and no CC cohorts was not significant for HCP costs nor total direct costs. Conclusions: These results indicate substantial economic burden in women diagnosed with CC in the US. In terms of HCRU and direct costs, treated CC patients incur the greatest burden, untreated CC patients incur the second greatest burden, and individuals without CC tend to incur the least burden.

scholarly journals A One-Year Health Economics Study Before and After Switching from Oral Antipsychotics to Once-Monthly Paliperidone Palmitate in Patients with Schizophrenia, A Retrospective, Prospective, Mirror-Image Study

2021 ◽  
Author(s):  
Jie Liu ◽  
Qian Wang ◽  
Lei Su ◽  
Limin Yang ◽  
Lianyong Zou ◽  
...  
Keyword(s):  
Health Care ◽  
Mental Health Center ◽  
Indirect Costs ◽  
Direct Costs ◽  
Paliperidone Palmitate ◽  
Treatment Modalities ◽  
Inpatient Stay ◽  
Hospitalization Costs ◽  
Before And After ◽  
One Year

Abstract Background: Schizophrenia is ranked among the top 25 leading causes of disability worldwide in 2013 which resulting in social and economic burden. By observing patients with schizophrenia one year before and after switching from oral antipsychotics (OAPs) to once-monthly paliperidone palmitate (PP1M), we can better understand the change of total costs in schizophrenic patients, including direct costs and indirect costs, after switching treatment patterns. Methods: A total of 100 schizophrenic (ICD-10) outpatient and inpatient patients from Shandong Mental Health Center were collected from December 2016 to June 2019. Treatment modalities, health care resource utilization and costs were compared before and after switching directly from oral antipsychotics to PP1M.Results: Of the 82 patients included in the main analyses, hospitalization costs decreased was partly offset by the increase of medical costs, which causing direct costs slightly increased (t=-1.81, P＞0.05). The reduction of productivity costs (t=2.06, P＜0.05) and caregiver care costs (t=1.99, P≤0.05) was seen at post-PP1M switch, therefore the indirect costs also obviously reduced (t=2.31, P＜0.05). Total costs slightly increased (t=-0.05, P＞0.05）compared to pre-PP1M period. For patients with ≥ 1 all-cause inpatient stay in the baseline period (n=32), compared with pre-PP1M, a fewer number of inpatient stays (t=1.73, P＜0.05) and hospitalizations (t=2.56, P≤0.01) were observed and a significant reduction in direct costs (t=2.20, P＜0.01) was observed post-transition to PP1M. Conclusions: Switching to PP1M from OAPs can improve adherence to therapy and not increase the costs of health care in the clinical. Patients with ≥1 recent all-cause inpatient stay had a significant reduction in direct costs after switching from oral antipsychotics to PP1M, suggesting that patients with ≥1 all-cause inpatient stay may benefit after switching to PP1M. Indirect costs decrease from OAPs to PP1M, suggesting that reduce the burden of the family labor after switch to PP1M.

Pharmacoeconomic study in head and neck cancer patients: Impact of prospective DPD deficiency screening with 5-fluorouracil (5-FU) dose tailoring on toxicities-related costs

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6515-6515 ◽  
Author(s):  
C. Mercier ◽  
C. Brunet ◽  
C. Yang ◽  
C. Dupuis ◽  
D. Bagarry-Liegey ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Dihydropyrimidine Dehydrogenase ◽  
Indirect Costs ◽  
Pharmacoeconomic Study ◽  
Systematic Screening ◽  
Standard Dosage ◽  
Hospitalization Costs ◽  
The Impact

6515 Background: Dihydropyrimidine dehydrogenase (DPD) plays a pivotal role in the detoxification of 5-FU. We studied the impact of screening DPD impairment in head and neck cancer (HNC) patients, both on reduction of drug-related toxicities and as a pharmacoeconomic endpoint. Methods: A total of 148 consecutive patients with HNC treated with 5-FU+platinum were monitored. Seventy-four patients (Arm A - before 2006) were treated with standard dosage, whereas 74 other patients (Arm B - after 2006) had their DPD status phenotypically evaluated prior to receiving 5-FU, with subsequent dose reduction if DPD deficiency were suspected. Severe toxicities and response were compared. Additionally, direct and indirect costs required to manage the treatment-related toxicities and to establish DPD status were calculated. Results: Sepsis was observed in 16.2% of patients treated with standard dosage. In Arm B, DPD deficiency was suspected in 35% of the patients and 5-FU dosage was subsequently reduced. Consequently, only 1.8% of them experienced sepsis. Of note, response rates were comparable between Arm A and B (62 vs 61%, p>0.05), thus demonstrating that 5-FU dose tailoring did not negatively impact on treatment efficacy, while reducing the occurrence of severe toxicities. Managing toxicities required an average 23-days of extra-hospitalization (4–96 days), including an average 1.6-day stay in ICU. No patients from Arm B had to stay in ICU. Drugs required for managing toxicities cost an average of $339 per patient (Arm A) and was reduced down to $38 per patient (Arm B). Similarly, mean extra-hospitalization cost was $5,940/patient in Arm A and $245/patient in Arm B. Testing DPD cost $49/patient in Arm B. Conclusions: Developing an adaptative dosing strategy based upon DPD status evaluation led to a dramatic reduction of the incidence of 5-FU-related severe toxicities, while maintaining optimal efficacy. Subsequently, extra-cost (medication + hospitalization costs) required to manage the toxicities fell down from $6,279 to $294/patient. Overall, this study advocates that systematic screening for DPD deficiency could be cost-efficient in the setting of 5-FU-based chemotherapies, with a reduction of 95% of the extra-costs. No significant financial relationships to disclose.

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