scholarly journals Treated Colorectal Cancer: What is the Cost to Primary Care?

2009 ◽  
Vol 3 ◽  
pp. CMO.S877
Author(s):  
D.A.L. Macafee ◽  
J. West ◽  
J.H. Scholefield ◽  
D.K. Whynes
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Early Stage ◽  
Geometric Mean ◽  
Retrospective Case ◽  
Total Cost ◽  
Stage Disease ◽  
The Cost ◽  
Direct Primary ◽  
Care Costs

Background Colorectal cancer is the second commonest cause of cancer death and the cost to primary care has not been estimated. Aim To determine the direct primary care costs of colorectal cancer care. Design Retrospective case note review. Setting Nottingham, United Kingdom. Methods We identified people with colorectal cancer between 1995 and 1998, from computerised pathology records. Colorectal cancer related resources consumed in primary care, from hospital discharge to death, were identified from retrospective notes review. Outcome measures were costs incurred by the General Practitioner (GP) and the total cost to primary care. We used multiple linear regression to identify predictors of cost. Results Of 416 people identified from pathology records, the median age at primary operation of the 135 (33%) people we selected was 74.2 (IQR 14.4) years, 75 (56%) were male. The median GP cost was: Dukes A £61.0 (IQR 516.2) and Dukes D £936.2 (1196.2) p < 0.01. The geometric mean ratio found Dukes D cancers to be 10 times as costly as Dukes A. The median total cost was: Dukes A £1038.3 (IQR 5090.6) and Dukes D £1815.2 (2092.5) p = 0.06. Using multivariate analysis, Dukes stage was the most important predictor of GP costs. For total costs, the presence of a permanent stoma was the most predictive variable, followed by adjuvant therapy and advanced Dukes stage (Dukes C and D). Conclusions Contrary to hospital based care costs, late stage disease (Dukes D) costs substantially more to general practice than any other stage. Stoma care products are the most costly prescribable item. Costs savings may be realised in primary care by screening detection of early stage colorectal cancers.

Evolution of Laparoscopic Surgery for Colorectal Cancer: The Impact of the Clinical Outcomes of Surgical Therapy Group Trial

2016 ◽  
Vol 82 (8) ◽  
pp. 685-691 ◽  
Author(s):  
Michelle Julien ◽  
James Dove ◽  
Kevin Quindlen ◽  
Kristen Halm ◽  
Mohsen Shabahang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Clinical Outcomes ◽  
Surgical Therapy ◽  
Early Stage ◽  
Therapy Group ◽  
Oncologic Outcomes ◽  
Tumor Stages ◽  
The Cost ◽  
The Impact ◽  
Colorectal Resections

The Clinical Outcomes of Surgical Therapy Group (COST) Trial established laparoscopic procedures offer short-term benefits while preserving the same oncologic outcomes in colorectal cancer (CRC) patients compared with open procedures. The aim of this study was to evaluate the trend of laparoscopic resection for CRC before and after the publication of the COST Trial. Retrospective study of surgically treated CRC patients was conducted from January 2000 to December 2009. Surveillance, Epidemiology, and End Results Program and Medicare. Between 2000 and 2009, 147,388 patients underwent resection for CRC, 9,901 resections were performed laparoscopically. In 2000, 1.0 per cent of colorectal resections were performed laparoscopically. There was a dramatic increase in laparoscopic resections in 2009 to 30.4 per cent. During this time period, rates of laparoscopic resections increased for all tumor stages. Right colectomies and early stage tumors had the most significant rise from 3.1 per cent (2004) to 38.7 per cent (2009) and 4.41 per cent (2004) to 39.17 per cent (2009), respectively; whereas, rectal and later stage tumors resection rates were more modest from 2.1 per cent (2004) to 13.2 per cent (2009) and 1.41 per cent (2004) to 17.10 per cent (2009), respectively. This study demonstrates the COST Trial had a significant impact on utilization of laparoscopic colorectal resection for CRC. Although laparoscopic colorectal resections have been accepted for all types of CRCs, more difficult procedures are being adopted at slower rates.

Variation in the cost of treatment for colorectal cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 3625-3625
Author(s):  
S. A. Ferro ◽  
L. E. Cosler ◽  
D. A. Wolff ◽  
M. S. Poniewierski ◽  
E. Culakova ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Growth Factor ◽  
Drug Product ◽  
Cost Of Treatment ◽  
Standard Regimen ◽  
Treatment Benefits ◽  
Standard Patient ◽  
Stage Disease ◽  
Cost Treatment ◽  
The Cost

3625 Background: Recent publications have drawn attention to the escalating costs of drugs utilized for the treatment and supportive care of colorectal cancer (CRC) patients. As more advanced chemotherapeutic and supportive agents are approved, the cost of treatment will likely continue to increase. The goal of this analysis was to estimate costs of frequently used CRC chemotherapeutics and other commonly prescribed agents. Methods: Costs of drugs in CRC regimens for patients participating in a prospective, observational study from 115 community oncology practices between March 2002 and March 2005 were calculated. Standard dosages and schedules were determined through literature review and an expert CRC oncologist. Trimmed mean (90%) costs were computed using average wholesale prices (AWP) retrieved from the Lexicon Database Drug Product (January 2005). All prices noted are 95% AWP. All chemotherapeutic drugs were combined to arrive at regimen specific prices. Other regimens were defined as regimens with less than four patients. Price per cycle was estimated based on a standard patient BSA of 2.0 m2 and standard regimen schedules. Growth factor costs were derived from expected per cycle utilization, while prices for other supportive drugs were calculated using dosages for single events. Results: Patients were categorized into the following regimens ( table below). The price of a commonly used monoclonal antibody is: Bevacizumab ($2613), based on every 2 week dosing. Growth factor prices (per cycle) were estimated: Filgrastim ($2499), Pegfilgrastim ($2928), Epoetin ($552), and Darbepoetin Alfa ($1002). Prices per event for other commonly used agents were: Atropine ($245), Loperamide ($3), Ondansetron ($931), and Granisetron ($232). Conclusions: Prices of CRC regimens vary considerably, with newer agents and supportive drugs adding substantially to costs, particularly in late stage disease. Research on improved outcomes or treatment benefits associated with high cost treatment is warranted. [Table: see text] [Table: see text]

scholarly journals A population-based comparison of treatment, resource utilization, and costs by cancer stage for Ontario patients with HER2-positive breast cancer

2020 ◽  
Author(s):  
Christine Brezden-Masley ◽  
Kelly E. Fathers ◽  
Megan E. Coombes ◽  
Behin Pourmirza ◽  
Cloris Xue ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Early Stage ◽  
Stage Iv ◽  
Population Based ◽  
Stage I ◽  
Publicly Funded ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Care Costs

Abstract Purpose We sought to expand the currently limited, Canadian, population-based data on the characteristics, treatment pathways, and health care costs according to stage in patients with human epidermal growth factor receptor-2 positive (HER2+) breast cancer (BC). Methods We extracted data from the publicly funded health care system in Ontario. Baseline characteristics, treatment patterns, and health care costs were descriptively compared by cancer stage (I–III vs. IV) for adult women diagnosed with invasive HER2+ BC between 2012 and 2016. Resource use was multiplied by unit costs for publicly funded health care services to calculate costs. Results Overall, 4535 patients with stage I–III and 354 with stage IV HER2+ BC were identified. Most patients with stage I–III disease were treated with surgery (4372, 96.4%), with the majority having a lumpectomy, and 3521 (77.6%) received radiation. Neoadjuvant (NAT) and adjuvant (AT) systemic treatment rates were 20.1% (n = 920) and 88.8% (n = 3065), respectively. Systemic treatment was received by 311 patients (87.9%) with metastatic HER2+ BC, 264 of whom (84.9%) received trastuzumab. Annual health care costs per patient were nearly 3 times higher for stage IV vs. stage I–III HER2+ BC. Conclusion Per-patient annual costs were substantially higher for women with metastatic HER2+ BC, despite less frequent exposure to surgery and radiation compared to those with early stage disease. Increasing NAT rates in early stage disease represent a critical opportunity to prevent recurrence and reduce the costs associated with treating metastatic HER2+ BC.

How Effective is Population-Based Cancer Screening? Regression Discontinuity Estimates from the US Guideline Screening Initiation Ages

2016 ◽  
Vol 19 (1) ◽  
pp. 87-139 ◽  
Author(s):  
Srikanth Kadiyala ◽  
Erin Strumpf
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Cancer Screening ◽  
Cancer Detection ◽  
Regression Discontinuity ◽  
Early Stage ◽  
Population Based ◽  
Detection Rates ◽  
Asymptomatic Case ◽  
The Cost

Abstract We estimate the marginal benefits of population-based cancer screening by comparing cancer test and detection rates on either side of US guideline-recommended initiation ages (age 40 for breast cancer and age 50 for colorectal cancer during the study period). Using a regression discontinuity design and self-reported test data from national health surveys, we find test rates for breast and colorectal cancer increase at the guideline age thresholds by 109% and 78%, respectively. Data from cancer registries in twelve US states indicate that cancer detection rates increase at the same thresholds by 50% and 49%, respectively. We estimate significant effects of screening on earlier breast cancer detection (1.2 cases/1000 screened) at age 40 and colorectal cancer detection (1.1 cases/1000 individuals screened) at age 50. Forty-eight and 73% of the increases in breast and colorectal case detection occur among middle-stage cancers (localized and regional) with most of the remainder among early-stage (in-situ). Our analysis suggests that the cost of detecting an asymptomatic case of breast cancer at age 40 via population-based screening is $107,000–134,000 and that the cost of detecting an asymptomatic case of colorectal cancer at age 50 is $473,000–485,000.

scholarly journals Cost Effectiveness of using Faecal Immunochemical Testing (FIT) as an Initial Diagnostic Investigation for Patients with Lower Gastrointestinal Symptoms Suggestive of Malignancy.

2021 ◽  
Author(s):  
Christopher Kearsey ◽  
Catherine Graham ◽  
Harry Lobb ◽  
Jerry Chako ◽  
Rachael Weatherburn ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Diagnostic Yield ◽  
Gastrointestinal Symptoms ◽  
Theoretical Data ◽  
Current Sensitivity ◽  
Predictive Values ◽  
Colorectal Malignancy ◽  
Total Cost ◽  
The Cost

Abstract BackgroundThere has been an increase in the numbers of patients presenting to primary care with suspected colorectal malignancy and subsequently an increase in demand for endoscopy. This study aims to forecast the cost of faecal immunochemical testing (FIT) compared to conventional diagnostic tests as a primary investigation for patients with symptoms suggestive of colorectal malignancy.MethodsRetrospectively, 1950 patients with symptoms suggestive of colorectal malignancy who were referred through primary care and underwent investigations through standard endoscopic evaluation were included. These patients were used to forecast the cost of faecal immunochemical testing creating theoretical data for sensitivity and specificity. Outcome measures included: the number of investigations under current protocol; cost of current investigations; number of predicted false negatives and false positives and positive/negative predictive values using current sensitivity data for FIT; the cost forecast of using FIT as the primary investigation for colorectal malignancy.Results: Median age was 65 (IQR 47-82) with 43.7% male and 56.3% female. A total of 1950 investigations were carried out with a diagnostic yield of 26 cancers (18 colon, 8 rectal), 138 polyps and 29 high risk adenomas (HGD +/- >10mm). In total, £713,948 was spent on the investigations. The commonest investigation was colonoscopy totalling £533,169. The total cost per cancer diagnosis was £27,459. Sensitivity (92.1% CI 86.9-95.3) and specificity (85.8% CI 78.3-90.1) for FIT in colorectal cancer was taken from NICE and was costed via the manufacturer(s). The projected total cost of FIT for the same population using a ≥4μg haemoglobin cut off was £415,680 (£15,554 per cancer). The total cost of high-risk polyps using ≥4μg cut off was £404,427 (sensitivity 71.2% CI 60.5-87.2, specificity 79.8%CI 76.1-83.7) or £13,945 per polyp.Conclusions: FIT is a cheaper and effective alternative test with the potential to replace current expensive methods. The forecast is based on the limited data available for sensitivity/specificity in the current literature. FIT has now been commenced for symptomatic patients in the UK and therefore sensitivity may change in the future.

scholarly journals What You Don’t Know Might Hurt You: Cost Variations for Fecal Immunochemical Tests in Primary Care Practices

2021 ◽  
Author(s):  
Jennifer Coury ◽  
Katrina Ramsey ◽  
Rose Gunn ◽  
Jon Judkins ◽  
Melinda Davis
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
P Value ◽  
Fecal Occult Blood ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Effective Manner ◽  
Care Practices ◽  
Primary Care Practices ◽  
The Cost

Abstract Background Colorectal cancer (CRC) screening can improve health outcomes, but screening rates remain low across the US. Fecal immunochemical testing (FIT) is an effective way to screen more people for colorectal cancer, but barriers exist to implementation in clinical practice. Little research examines the impacts of cost on FIT selection and implemention. Methods We administered a multi-modal, cross-sectional survey to 252 primary care practices to assess readiness and implementation of direct mail fecal testing programs, including the cost and types of FIT used. We analyzed the range of costs for the tests, and identified practice and test procurement factors. We examined the distributions of practice characteristics for FIT use and costs answers using the non-parametric Wilcoxon rank-sum test. We used Pearson's chi-squared test of association and interpreted a low p-value (e.g. <0.05) as evidence of association between a given practice characteristic and knowing the cost of FIT or fecal occult blood test (FOBT). Results Among the 84 practice survey responses, more than 10 different types of FIT/FOBTs were in use; 76% of practices used one of the five most common FIT types. Only 40 practices (48%) provided information on the cost of their FIT/FOBTs. Thirteen (32%) of these practices received the tests for free while 27 (68%) paid for their tests; median reported cost of a FIT was $3.04, with a range from $0.83 to $6.41 per test. Costs were not statistically significant different by FIT type. However, practices who received FITs from vendors were more likely to know the cost (p = 0.0002) and, if known, report a higher cost (p = 0.0002). Conclusions Our findings indicate that most practices without lab or health system supplied FITs are spending more to procure tests. Cost of FIT may impact the willingness of practices to distribute FITs in clinic-based encounters as well as through population outreach strategies, such as mailed FIT. Differences in the ability to obtain FIT tests in a cost-effective manner could have far reaching consequences for addressing colorectal cancer screening disparities in primary care practices.

Novel Biomarker-Targeted Therapies for Metastatic Colorectal Cancer

2021 ◽  
Author(s):  
Shimoli V. Barot ◽  
Suneel D. Kamath
Keyword(s):  
Colorectal Cancer ◽  
Growth Factor ◽  
Metastatic Disease ◽  
Targeted Therapies ◽  
Early Stage ◽  
Growth Factor Receptor ◽  
Precision Oncology ◽  
Dynamic Heterogeneity ◽  
Early Stage Disease ◽  
Stage Disease

AbstractColorectal cancer (CRC) is one of the most common and fatal malignancies worldwide. Screening, surgery, and adjuvant therapy have proved efficacious in improving outcomes for early-stage disease. Despite decades of research efforts, cytotoxic chemotherapy has been the mainstay of treatment for metastatic disease and the prognosis remains unsatisfactory. Compelling evidence suggests that a fundamental reason for the limited success is the cancer's inherent dynamic heterogeneity, which is more predominant in late-stage disease. As our understanding of this molecular blueprint of CRC has evolved, a new avenue of targeted therapies has emerged. Beginning with epidermal growth factor receptor and vascular endothelial growth factor inhibitors, numerous targeted agents have been developed and investigated in large, multicenter, prospective clinical trials. Testing for mutations in RAS (KRAS and NRAS), BRAF, and HER2 and for mismatch repair/microsatellite instability and NTRK fusions has now been incorporated in the management guidelines, with additional biomarkers rapidly surfacing. As we enter the latest paradigm of precision oncology in CRC, this article will provide an overview of the different molecular subsets of CRC and the current biomarker-targeted therapies in the management of metastatic disease.

scholarly journals L1CAM expression in colorectal cancer identifies patients prone to metastasis already in early-stage disease

2019 ◽  
Vol 30 ◽  
pp. iv60
Author(s):  
A. Tampakis ◽  
E. Tampaki ◽  
A. Nonni ◽  
E. Patsouris ◽  
M. von Flüe ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Early Stage ◽  
Early Stage Disease ◽  
Stage Disease ◽  
L1cam Expression
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