ABSTRACT
Objective: To measure 3-year care costs of breast, prostate, colorectal and lung cancers disaggregated by site and clinical stage. Method: A retrospective observational design was employed to investigate care costs of cases recorded in the Registry of the Basque Country between 2010 and 2015. Data gathered included TNM stage and demographic, clinical and resource use variables. Total costs per patient with stage IV disease were calculated by combining generalized linear models with parametric survival analysis. Unit costs were obtained from the analytical accounting system of the Basque Health Service. Results: The sample comprised 23,782 cancer cases (7801 colorectal, 5530 breast, 4802 prostate and 5649 lung cancer). The mean 3-year costs per patient with stage I to III disease were 11,323, 13,727, 8,651 and 12,023 for colorectal, breast, prostate and lung cancer, respectively. The most important cost components were surgery and chemotherapy. Total survival-adjusted costs until death for patients with stage IV disease (27,568, 26,296, 16,151 and 15,931 for breast, colorectal, lung and prostate cancer, respectively) were higher than the 3-year costs for those with earlier-stage disease. Conclusions: This study quantitatively shows the pattern of changes in the economic burden of cancer throughout its natural history and the great magnitude of this burden for the health system. The use of indicators based on real-world data from each regional health service would allow cancer care in each region to be tailored to local population needs. (AU)
Objetivo: Determinar el coste del tratamiento de los cánceres de mama, próstata, colorrectal y pulmón según la localización y el estadio clínico. Método: Se utilizó un diseño observacional retrospectivo con los casos del Registro de Euskadi entre 2010 y 2015. Los datos incluyeron el estadio TNM, variables demográficas y clínicas, y uso de recursos. Los costes totales por paciente en estadio IV se calcularon combinando modelos lineales generalizados con el análisis paramétrico de supervivencia. Los costes unitarios se obtuvieron del sistema de contabilidad analítica del Servicio Vasco de Salud. Resultados: La muestra estuvo compuesta por 23.782 casos (7801 colorrectal, 5530 de mama, 4802 de próstata y 5649 de pulmón). Los costes medios por paciente a 3 años en estadio I a III fueron 11.323 , 13.727 , 8651 y 12.023 para los cánceres colorrectal, de mama, de próstata y de pulmón, respectivamente. Los costes para el estadio IV (27.568 , 26.296 , 16.151 y 15.931 para los cánceres de mama, colorrectal, de pulmón y de próstata, respectivamente) fueron mayores que en los estadios iniciales. Conclusiones: Este estudio muestra cuantitativamente el cambio en la carga económica del cáncer a lo largo de su evolución y la gran carga que supone para el sistema de salud. El uso de datos del mundo real de cada servicio de salud permitiría adaptar la atención del cáncer a las necesidades de la población local. (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Prostatic Neoplasms , Breast Neoplasms , Lung Neoplasms , Health Care Costs , Colorectal Neoplasms , Retrospective StudiesABSTRACT
Objective: To conduct a stratified cost-utility analysis of total versus partial hip arthroplasty as a function of clinical subtype. Method: All cases of this type of intervention were analysed between 2010 and 2016 in the Basque Health Service, gathering data on clinical outcomes and resource use to calculate the cost and utility in quality-adjusted life years (QALYs) at individual level. The statistical analysis included applying the propensity score to balance the groups, and seemingly unrelated regression models to calculate the incremental cost-utility ratio and plot the cost-effectiveness plane. The interaction between age group and American Society of Anesthesiologists (ASA) risk class was assessed in the multivariate analysis. Results: The study identified 5867 patients diagnosed with femoral neck fracture, of whom 1307 and 4560 were treated with total and partial hip arthroplasty, respectively. In the cost-utility analysis based on the seemingly unrelated regression, total hip arthroplasty was found to have a higher cost and higher utility (2465 and 0.42 QALYs). Considering a willingness-to-pay threshold of 22,000 per QALY, total hip arthroplasty was cost-effective in the under-80-year-old subgroup. Among patients above this age, hemiarthroplasty was cost-effective in ASA class I-II patients and dominant in ASA class III-IV patients. Conclusions: Subgroup analysis supports current daily clinical practice in displaced femoral neck fractures, namely, using partial replacement in most patients and reserving total replacement for younger patients. (AU)
Objetivo: Realizar un análisis de coste-utilidad de la prótesis total de cadera frente a la prótesis parcial. Método: Se analizaron todos los casos intervenidos desde 2010 hasta 2016 en el Servicio Vasco de Salud, recogiendo resultados clínicos y uso de recursos para calcular individualmente el coste y la utilidad en años de vida ajustados por calidad (AVAC). El análisis estadístico incluyó el pareamiento por puntaje de propensión para balancear los grupos y modelos de regresión aparentemente no relacionados para calcular la razón de coste-utilidad incremental y el plano de coste-efectividad. La interacción de grupo de edad y riesgo según la American Society of Anesthesiologists (ASA) se incluyó en el análisis multivariante. Resultados: Se identificaron 1307 pacientes con prótesis total y 4560 con prótesis parcial. Al hacer el análisis de coste-utilidad con modelos de regresión aparentemente no relacionados el resultado fue mayor coste y mayor utilidad para la prótesis total (2465 y 0,42 AVAC). Para un umbral de 22.000 por AVAC, la prótesis total fue coste-efectiva en el subgrupo de menores de 80 años. En el grupo de mayores de 80 años la parcial fue coste-efectiva en los casos con riesgo ASA I-II y dominante en los ASA III-IV. Conclusiones: El análisis de subgrupos ratifica la práctica clínica habitual en las fracturas de cuello de fémur desplazadas de intervenir a la mayoría de los pacientes mediante prótesis parcial y reservar la prótesis total para los pacientes más jóvenes. (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Femoral Neck Fractures , Hip , Hip Prosthesis , Hemiarthroplasty , Multivariate Analysis , Cost-Benefit AnalysisABSTRACT
OBJECTIVE: To measure 3-year care costs of breast, prostate, colorectal and lung cancers disaggregated by site and clinical stage. METHOD: A retrospective observational design was employed to investigate care costs of cases recorded in the Registry of the Basque Country between 2010 and 2015. Data gathered included TNM stage and demographic, clinical and resource use variables. Total costs per patient with stage IV disease were calculated by combining generalized linear models with parametric survival analysis. Unit costs were obtained from the analytical accounting system of the Basque Health Service. RESULTS: The sample comprised 23,782 cancer cases (7801 colorectal, 5530 breast, 4802 prostate and 5649 lung cancer). The mean 3-year costs per patient with stage I to III disease were 11,323, 13,727, 8,651 and 12,023 for colorectal, breast, prostate and lung cancer, respectively. The most important cost components were surgery and chemotherapy. Total survival-adjusted costs until death for patients with stage IV disease (27,568, 26,296, 16,151 and 15,931 for breast, colorectal, lung and prostate cancer, respectively) were higher than the 3-year costs for those with earlier-stage disease. CONCLUSIONS: This study quantitatively shows the pattern of changes in the economic burden of cancer throughout its natural history and the great magnitude of this burden for the health system. The use of indicators based on real-world data from each regional health service would allow cancer care in each region to be tailored to local population needs.
Subject(s)
Colorectal Neoplasms , Lung Neoplasms , Colorectal Neoplasms/pathology , Colorectal Neoplasms/therapy , Health Care Costs , Humans , Lung/pathology , Lung Neoplasms/therapy , Male , Neoplasm Staging , Prostate/pathology , Retrospective StudiesABSTRACT
OBJECTIVE: To conduct a stratified cost-utility analysis of total versus partial hip arthroplasty as a function of clinical subtype. METHOD: All cases of this type of intervention were analysed between 2010 and 2016 in the Basque Health Service, gathering data on clinical outcomes and resource use to calculate the cost and utility in quality-adjusted life years (QALYs) at individual level. The statistical analysis included applying the propensity score to balance the groups, and seemingly unrelated regression models to calculate the incremental cost-utility ratio and plot the cost-effectiveness plane. The interaction between age group and American Society of Anesthesiologists (ASA) risk class was assessed in the multivariate analysis. RESULTS: The study identified 5867 patients diagnosed with femoral neck fracture, of whom 1307 and 4560 were treated with total and partial hip arthroplasty, respectively. In the cost-utility analysis based on the seemingly unrelated regression, total hip arthroplasty was found to have a higher cost and higher utility (2465 and 0.42 QALYs). Considering a willingness-to-pay threshold of 22,000 per QALY, total hip arthroplasty was cost-effective in the under-80-year-old subgroup. Among patients above this age, hemiarthroplasty was cost-effective in ASA class I-II patients and dominant in ASA class III-IV patients. CONCLUSIONS: Subgroup analysis supports current daily clinical practice in displaced femoral neck fractures, namely, using partial replacement in most patients and reserving total replacement for younger patients.
Subject(s)
Arthroplasty, Replacement, Hip , Femoral Neck Fractures , Hemiarthroplasty , Cost-Benefit Analysis , Femoral Neck Fractures/surgery , Humans , Quality-Adjusted Life Years , Treatment OutcomeABSTRACT
BACKGROUND: The Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013. Faecal immunological testing was used for screening in individuals between 50 and 69 years old. Colorectal Cancer in Basque country is characterized by unusual epidemiological features given that Colorectal Cancer incidence is similar to other European countries while adenoma prevalence is higher. The object of our study was to economically evaluate the programme via cost-effectiveness and budget impact analyses with microsimulation models. METHODS: We applied the Microsimulation Screening Analysis (MISCAN)-Colon model to predict trends in Colorectal Cancer incidence and mortality and to quantify the short- and long-term effects and costs of the Basque Colorectal Cancer Screening Programme. The model was calibrated to the Basque demographics in 2008 and age-specific Colorectal Cancer incidence data in the Basque Cancer Registry from 2005 to 2008 before the screening begun. The model was also calibrated to the high adenoma prevalence observed for the Basque population in a previously published study. The multi-cohort approach used in the model included all the cohorts in the programme during 30 years of implementation, with lifetime follow-up. Unit costs were obtained from the Basque Health Service and both cost-effectiveness analysis and budget impact analysis were carried out. RESULTS: The goodness-of-fit of the model adaptation to observed programme data was evidence of validation. In the cost-effectiveness analysis, the savings from treatment were larger than the added costs due to screening. Thus, the Basque programme was dominant compared to no screening, as life expectancy increased by 29.3 days per person. The savings in the budget analysis appeared 10 years after the complete implementation of the programme. The average annual budget was 73.4 million from year 2023 onwards. CONCLUSIONS: This economic evaluation showed a screening intervention with a major health gain that also produced net savings when a long follow-up was used to capture the late economic benefit. The number of colonoscopies required was high but remain within the capacity of the Basque Health Service. So far in Europe, no other population Colorectal Cancer screening programme has been evaluated by budget impact analysis.
Subject(s)
Adenoma/epidemiology , Colorectal Neoplasms/epidemiology , Mass Screening/economics , Models, Theoretical , Adenoma/pathology , Aged , Colorectal Neoplasms/pathology , Computer Simulation , Cost-Benefit Analysis , Female , Humans , Male , Middle Aged , Population Surveillance , PrevalenceABSTRACT
INTRODUCTION: The aim of this study was to measure the cost of treatment of colorectal cancer in the Basque public health system according to the clinical stage. METHODS: We retrospectively collected demographic data, clinical data and resource use of a sample of 529 patients. For stagesi toiii the initial and follow-up costs were measured. The calculation of cost for stageiv combined generalized linear models to relate the cost to the duration of follow-up based on parametric survival analysis. Unit costs were obtained from the analytical accounting system of the Basque Health Service. RESULTS: The sample included 110 patients with stagei, 171 with stageii, 158 with stageiii and 90 with stageiv colorectal cancer. The initial total cost per patient was 8,644 for stagei, 12,675 for stageii and 13,034 for stageiii. The main component was hospitalization cost. Calculated by extrapolation for stageiv mean survival was 1.27years. Its average annual cost was 22,403, and 24,509 to death. The total annual cost for colorectal cancer extrapolated to the whole Spanish health system was 623.9million. CONCLUSIONS: The economic burden of colorectal cancer is important and should be taken into account in decision-making. The combination of generalized linear models and survival analysis allows estimation of the cost of metastatic stage.
Subject(s)
Colorectal Neoplasms/economics , Colorectal Neoplasms/pathology , Cost of Illness , Health Care Costs , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Neoplasm Staging , Retrospective StudiesABSTRACT
INTRODUCCIÓN: El objetivo de este trabajo fue medir el coste del tratamiento del cáncer colorrectal en un hospital del sistema sanitario público vasco según el estadio clínico. MÉTODOS: Se recogieron de forma retrospectiva variables demográficas, clínicas y uso de recursos de una muestra de 529 pacientes. Para los estadios I a III se midieron los costes iniciales y de seguimiento. El coste del estadio IV combinó los modelos lineales generalizados para relacionar el coste con la duración del seguimiento con el análisis de supervivencia de tipo paramétrico. Los costes unitarios se obtuvieron del sistema de contabilidad analítica del Servicio Vasco de Salud. RESULTADOS: La muestra se distribuyó en 110 pacientes en estadio I, 171 en estadio II, 158 en el estadio III y 90 en el estadio IV. El coste total inicial por paciente fue de 8.644 euros (Euros) en el estadio I, 12.675 Euros en el estadio II y 13.034 Euros en el estadio III. El principal componente del coste fue la hospitalización. La supervivencia media calculada por extrapolación para el estadio IV fue de 1,27 años. Su coste anual medio fue de 22.403 Euros, y de 24.509 Euros hasta el fallecimiento. El coste anual total para el tratamiento del cáncer colorrectal extrapolado a toda España fue de 623.900.000 Euros. CONCLUSIONES: La carga económica del cáncer colorrectal es importante y debe ser tenida en cuenta en la toma de decisiones. La combinación de los modelos lineales generalizados y el análisis de supervivencia para relacionar el coste con el seguimiento permite estimar el coste del estadio metastásico
INTRODUCTION: The aim of this study was to measure the cost of treatment of colorectal cancer in the Basque public health system according to the clinical stage. METHODS: We retrospectively collected demographic data, clinical data and resource use of a sample of 529 patients. For stages I to III the initial and follow-up costs were measured. The calculation of cost for stage IV combined generalized linear models to relate the cost to the duration of follow-up based on parametric survival analysis. Unit costs were obtained from the analytical accounting system of the Basque Health Service. RESULTS: The sample included 110 patients with stage I, 171 with stage II, 158 with stage III and 90 with stage IV colorectal cancer. The initial total cost per patient was 8,644 Euros for stage I, 12,675 Euros for stage II and 13,034 Euros for stage III. The main component was hospitalization cost. Calculated by extrapolation for stage IV mean survival was 1.27 years. Its average annual cost was 22,403 Euros, and 24,509 Euros to death. The total annual cost for colorectal cancer extrapolated to the whole Spanish health system was 623.9 million Euros. CONCLUSIONS: The economic burden of colorectal cancer is important and should be taken into account in decision-making. The combination of generalized linear models and survival analysis allows estimation of the cost of metastatic stage
