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1.
World Neurosurg ; 157: e215-e222, 2022 01.
Article in English | MEDLINE | ID: mdl-34653705

ABSTRACT

BACKGROUND: Laser interstitial thermal therapy (LITT) is a minimally invasive alternative to anterior temporal lobectomy (ATL) for treatment of temporal lobe epilepsy. It has gained popularity as familiarity with technique increases and outcomes are better characterized. There has been no direct cost comparison between the 2 techniques in literature to date. The current study directly compares hospital costs associated with LITT with those of ATL patients and analyzes the factors potentially responsible for those costs. METHODS: Patients who underwent ATL (27) and LITT (15) were retrospectively reviewed for total hospital costs along with demographic, surgical, and postoperative factors potentially affecting cost. T-tests were used to compare costs and independent linear regressions, and hierarchical regressions were used to examine predictors of cost for each procedure. RESULTS: Mean hospital costs of admission for single-trajectory LITT ($104,929.88) were significantly less than for ATL ($134,980.04) (P = 0.001). In addition, length of stay, anesthesia costs, operative room costs, and postoperative hospitalization costs were all significantly lower in LITT. CONCLUSIONS: Given the minimally invasive nature of LITT, it is associated with shorter length of stay and lower hospital costs than ATL in the first head-to-head comparison of procedural costs in literature to date. Long-term efficacy as it relates to these costs associated with LITT and ATL should be further investigated to better characterize the utility of LITT in temporal lobe epilepsy patients.


Subject(s)
Anterior Temporal Lobectomy/economics , Epilepsy, Temporal Lobe/economics , Health Care Costs , Hyperthermia, Induced/economics , Laser Therapy/economics , Adult , Anterior Temporal Lobectomy/trends , Cohort Studies , Epilepsy, Temporal Lobe/therapy , Extracellular Fluid , Female , Health Care Costs/trends , Humans , Hyperthermia, Induced/trends , Laser Therapy/trends , Male , Middle Aged , Retrospective Studies , Treatment Outcome
2.
Curr Urol Rep ; 22(1): 4, 2021 Jan 06.
Article in English | MEDLINE | ID: mdl-33403529

ABSTRACT

PURPOSE OF REVIEW: Rezum® is a novel convection-based thermal therapy for benign prostatic hyperplasia (BPH) induced lower urinary tract symptoms (LUTS). This review provides an overview of its safety, efficacy, cost, and potential role in the paradigm of BPH/LUTS therapies. RECENT FINDINGS: Data regarding Rezum® stems primarily from one large randomized controlled trial of 197 patients with 4 years of follow-up. The efficacy and safety of Rezum® is further supported by 4 additional studies including 1 prospective pilot study, 1 crossover study, and 2 retrospective studies. Durable improvements in IPSS (47-60%), QoL (38-52%), Qmax (45-72%), and PVR (11-38%) were seen without causing deterioration of sexual function. Rezum® offers a cost-effective and safe approach to treating BPH/LUTS and should be considered as a possible first-line therapy for patients with moderate to severe symptoms.


Subject(s)
Ablation Techniques/methods , Lower Urinary Tract Symptoms/surgery , Prostatic Hyperplasia/surgery , Steam , Transurethral Resection of Prostate/methods , Ablation Techniques/economics , Ablation Techniques/trends , Convection , Cystoscopy , Humans , Hyperthermia, Induced/economics , Hyperthermia, Induced/methods , Hyperthermia, Induced/trends , Lower Urinary Tract Symptoms/economics , Lower Urinary Tract Symptoms/etiology , Magnetic Resonance Imaging , Male , Prostate/diagnostic imaging , Prostate/surgery , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/diagnostic imaging , Prostatic Hyperplasia/economics , Transurethral Resection of Prostate/economics , Transurethral Resection of Prostate/trends , Treatment Outcome
3.
Pediatr Neurosurg ; 55(3): 141-148, 2020.
Article in English | MEDLINE | ID: mdl-32829333

ABSTRACT

INTRODUCTION: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a new technology that provides a clinically efficacious and minimally invasive alternative to conventional microsurgical resection. However, little data exist on how costs compare to traditional open surgery. The goal of this paper is to investigate the cost-effectiveness of MRgLITT in the treatment of pediatric epilepsy. METHODS: We retrospectively analyzed the medical records of pediatric patients who underwent MRgLITT via the Visualase® thermal therapy system (Medtronic, Inc., Minneapolis, MN, USA) between December 2013 and September 2017. Direct costs associated with preoperative, operative, and follow-up care were extracted. Benefit was calculated in quality-adjusted life years (QALYs), and the cost-effectiveness was derived from the discounted total direct costs over QALY. Sensitivity analysis on 4 variables was utilized to assess the validity of our results. RESULTS: Twelve consecutive pediatric patients with medically refractory epilepsy underwent MRgLITT procedures. At the last postoperative follow-up, 8 patients were seizure free (Engel I, 66.7%), 2 demonstrated significant improvement (Engel II, 16.7%), and 2 patients showed worthwhile improvement (Engel III, 16.7%). The average cumulative discounted QALY was 2.11 over the lifetime of a patient. Adjusting for inflation, MRgLITT procedures had a cost-effectiveness of USD 22,211 per QALY. Our sensitivity analysis of cost variables is robust and supports the procedure to be cost--effective. CONCLUSION: Our data suggests that MRgLITT may be a cost-effective alternative to traditional surgical resection in pediatric epilepsy surgery.


Subject(s)
Cost-Benefit Analysis/methods , Drug Resistant Epilepsy/surgery , Hyperthermia, Induced/methods , Intraoperative Neurophysiological Monitoring/methods , Laser Therapy/methods , Magnetic Resonance Imaging/methods , Adolescent , Child , Child, Preschool , Drug Resistant Epilepsy/diagnostic imaging , Drug Resistant Epilepsy/economics , Extracellular Fluid/physiology , Female , Follow-Up Studies , Humans , Hyperthermia, Induced/economics , Intraoperative Neurophysiological Monitoring/economics , Laser Therapy/economics , Magnetic Resonance Imaging/economics , Male , Retrospective Studies , Young Adult
4.
Eur J Surg Oncol ; 46(4 Pt A): 607-612, 2020 04.
Article in English | MEDLINE | ID: mdl-31982207

ABSTRACT

INTRODUCTION: This study aimed to evaluate the costs of CRS and HIPEC and treatment of the related postoperative complications in the public healthcare system. We also aimed to identify the risk factors that increase the cost of CRS and HIPEC. MATERIALS AND METHODS: We retrospectively evaluated 80 patients who underwent CRS and HIPEC between February 2016 and November 2018 in the Department of Surgery, University Hospital of Olomouc, Czech Republic. Intraoperative factors and postoperative complications were assessed. The treatment cost included the surgery, hospital stay, intensive care unit (ICU) admission, pharmaceutical charges including medication, hospital supplies, pathology, imaging, and allied healthcare services. RESULTS: The postoperative morbidity rate was 50%, and the mortality rate was 2.5%. The mean length of hospitalisation and ICU admission was 15.44 ± 8.43 and 6.15 ± 4.12 for all 80 patients and 10.73 ± 2.93 and 3.73 ± 1.32, respectively, for 40 patients without complications, and 20.15 ± 13.93 and 8.58 ± 6.92, respectively, for 40 patients with complications. The total treatment cost reached €606,358, but the total reimbursement was €262,931; thus, the CRS and HIPEC profit margin was €-343,427. Multivariate analysis showed that blood loss ≥1.000 ml (p = 0.03) and grade I-V Clavien-Dindo complications (p < 0.001) were independently associated with increased costs. CONCLUSION: The Czech public health insurance system does not fully compensate for the costs of CRS and HIPEC. Hospital losses remain the main limiting factor for further improving these procedures. Furthermore, treatment costs increase with increasing severity of postoperative complications.


Subject(s)
Cytoreduction Surgical Procedures/economics , Financing, Government , Hyperthermia, Induced/economics , Insurance, Health, Reimbursement/statistics & numerical data , Insurance, Health , Peritoneal Neoplasms/therapy , Postoperative Complications/economics , Adult , Aged , Appendiceal Neoplasms/pathology , Blood Loss, Surgical/statistics & numerical data , Colorectal Neoplasms/pathology , Costs and Cost Analysis , Czech Republic/epidemiology , Diagnostic Imaging/economics , Equipment and Supplies, Hospital/economics , Female , Healthcare Financing , Hospital Mortality , Humans , Intensive Care Units/economics , Intensive Care Units/statistics & numerical data , Length of Stay/economics , Length of Stay/statistics & numerical data , Male , Middle Aged , Ovarian Neoplasms/pathology , Peritoneal Neoplasms/secondary , Pharmaceutical Services/economics , Postoperative Complications/epidemiology
5.
PLoS One ; 14(11): e0224571, 2019.
Article in English | MEDLINE | ID: mdl-31747402

ABSTRACT

BACKGROUND: MRI-guided laser interstitial thermal therapy (MRgLITT) is a new minimally invasive treatment for temporal lobe epilepsy (TLE), with limited effectiveness data. It is unknown if the cost savings associated with shorter hospitalization could offset the high equipment cost of MRgLITT. We examined the cost-utility of MRgLITT versus surgery for TLE from healthcare payer perspective, and the value of additional research to inform policy decision on MRgLITT. METHODS: We developed a microsimulation model to evaluate quality adjusted life years (QALYs), costs, and incremental cost-effectiveness ratio (ICER) of MRgLITT versus surgery in TLE, assuming life-time horizon and 1.5% discount rate. Model inputs were derived from the literature. We conducted threshold and sensitivity analyses to examine parameter uncertainties, and expected value of partial perfect information analyses to evaluate the expected monetary benefit of eliminating uncertainty on probabilities associated with MRgLITT. RESULTS: MRgLITT yielded 0.08 more QALYs and cost $7,821 higher than surgery, with ICER of $94,350/QALY. Influential parameters that could change model outcomes include probabilities of becoming seizure-free from disabling seizures state and returning to disabling seizures from seizure-free state 5 years after surgery and MRgLITT, cost of MRgLITT disposable equipment, and utilities of disabling seizures and seizure-free states of surgery and MRgLITT. The cost-effectiveness acceptability curve showed surgery was preferred in more than 50% of iterations. The expected monetary benefit of eliminating uncertainty for probabilities associated with MRgLITT was higher than for utilities associated with MRgLITT. CONCLUSIONS: MRgLITT resulted in more QALYs gained and higher costs compared to surgery in the base-case. The model was sensitive to variations in the cost of MRgLITT disposable equipment. There is value in conducting more research to reduce uncertainty on the probabilities and utilities of MRgLITT, but priority should be given to research focusing on improving the precision of estimates on effectiveness of MRgLITT.


Subject(s)
Cost-Benefit Analysis , Drug Resistant Epilepsy/surgery , Epilepsy, Temporal Lobe/surgery , Hyperthermia, Induced/economics , Neurosurgical Procedures/economics , Adult , Computer Simulation , Drug Resistant Epilepsy/diagnostic imaging , Drug Resistant Epilepsy/economics , Epilepsy, Temporal Lobe/diagnostic imaging , Epilepsy, Temporal Lobe/economics , Female , Humans , Hyperthermia, Induced/methods , Magnetic Resonance Imaging, Interventional/economics , Magnetic Resonance Imaging, Interventional/methods , Male , Minimally Invasive Surgical Procedures/economics , Minimally Invasive Surgical Procedures/methods , Models, Economic , Neurosurgical Procedures/methods , Patient Selection , Quality-Adjusted Life Years , Surgery, Computer-Assisted/economics , Surgery, Computer-Assisted/methods , Treatment Outcome
6.
Am J Trop Med Hyg ; 101(6): 1373-1379, 2019 12.
Article in English | MEDLINE | ID: mdl-31595864

ABSTRACT

Cutaneous leishmaniasis (CL), a neglected parasitic skin disease, is endemic in Pakistan, where Leishmania tropica and Leishmania major are the causative protozoan species. Standard treatment with antimonial injections is long, painful, and costly; has toxic side effects; and is not always available in public hospitals. Small pilot studies have previously evaluated a low-cost and noninvasive hand-held exothermic crystallization thermotherapy for cutaneous leishmaniasis (HECT-CL) device. We aimed to further establish the effectiveness, safety, and feasibility of HECT-CL in L. tropica. In a prospective observational study, patients with parasitological confirmation of CL were treated using the HECT-CL heat pack for 3 minutes with an initial temperature of 52-53°C for 7 consecutive days. Dried blood spot samples were taken for species identification by polymerase chain reaction (PCR). Effectiveness was assessed by using medical photographs and measurements of the lesion size at baseline and subsequent follow-up visits, for up to 180 days. We intended to enroll 317 patients. The HECT-CL treatment was easy to apply and well tolerated. Species identification demonstrated the presence of L. tropica. Interim analysis of 56 patients showed a failure rate of 91% at follow-up (median 45 days after treatment, interquartile range 30-60 days). Enrollment of patients was prematurely suspended because of futility. This study showed a high failure rate for HECT-CL thermotherapy in this setting. Leishmania tropica is known to be less sensitive to antileishmanial drugs, more temperature-resistant, and spontaneous healing is slower than that in L. major. More research is needed to identify low-cost, effective, and more patient-friendly treatment for L. tropica.


Subject(s)
Early Termination of Clinical Trials , Equipment and Supplies/standards , Hyperthermia, Induced/economics , Hyperthermia, Induced/instrumentation , Leishmaniasis, Cutaneous/therapy , Adolescent , Adult , Child , Costs and Cost Analysis , Female , Humans , Leishmania tropica/genetics , Leishmania tropica/pathogenicity , Leishmaniasis, Cutaneous/parasitology , Male , Pakistan , Prospective Studies , Treatment Failure , Young Adult
7.
BMC Cancer ; 19(1): 420, 2019 May 06.
Article in English | MEDLINE | ID: mdl-31060544

ABSTRACT

BACKGROUND: At present, palliative systemic chemotherapy is the standard treatment in the Netherlands for gastric cancer patients with peritoneal dissemination. In contrast to lymphatic and haematogenous dissemination, peritoneal dissemination may be regarded as locoregional spread of disease. Administering cytotoxic drugs directly into the peritoneal cavity has an advantage over systemic chemotherapy since high concentrations can be delivered directly into the peritoneal cavity with limited systemic toxicity. The combination of a radical gastrectomy with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has shown promising results in patients with gastric cancer in Asia. However, the results obtained in Asian patients cannot be extrapolated to Western patients. The aim of this study is to compare the overall survival between patients with gastric cancer with limited peritoneal dissemination and/or tumour positive peritoneal cytology treated with palliative systemic chemotherapy, and those treated with gastrectomy, CRS and HIPEC after neoadjuvant systemic chemotherapy. METHODS: In this multicentre randomised controlled two-armed phase III trial, 106 patients will be randomised (1:1) between palliative systemic chemotherapy only (standard treatment) and gastrectomy, CRS and HIPEC (experimental treatment) after 3-4 cycles of systemic chemotherapy.Patients with gastric cancer are eligible for inclusion if (1) the primary cT3-cT4 gastric tumour including regional lymph nodes is considered to be resectable, (2) limited peritoneal dissemination (Peritoneal Cancer Index < 7) and/or tumour positive peritoneal cytology are confirmed by laparoscopy or laparotomy, and (3) systemic chemotherapy was given (prior to inclusion) without disease progression. DISCUSSION: The PERISCOPE II study will determine whether gastric cancer patients with limited peritoneal dissemination and/or tumour positive peritoneal cytology treated with systemic chemotherapy, gastrectomy, CRS and HIPEC have a survival benefit over patients treated with palliative systemic chemotherapy only. TRIAL REGISTRATION: clinicaltrials.gov NCT03348150 ; registration date November 2017; first enrolment November 2017; expected end date December 2022; trial status: Ongoing.


Subject(s)
Cytoreduction Surgical Procedures/methods , Hyperthermia, Induced/methods , Palliative Care/methods , Peritoneal Neoplasms/therapy , Stomach Neoplasms/therapy , Adult , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Chemotherapy, Adjuvant/economics , Chemotherapy, Adjuvant/methods , Clinical Trials, Phase III as Topic , Cost-Benefit Analysis , Cytoreduction Surgical Procedures/economics , Disease-Free Survival , Female , Gastrectomy/economics , Gastrectomy/methods , Humans , Hyperthermia, Induced/economics , Kaplan-Meier Estimate , Male , Multicenter Studies as Topic , Netherlands/epidemiology , Palliative Care/economics , Peritoneal Neoplasms/economics , Peritoneal Neoplasms/secondary , Peritoneum/pathology , Randomized Controlled Trials as Topic , Stomach Neoplasms/economics , Stomach Neoplasms/pathology
8.
Gynecol Oncol ; 153(2): 376-380, 2019 05.
Article in English | MEDLINE | ID: mdl-30718126

ABSTRACT

OBJECTIVES: A recent randomized controlled trial demonstrated an overall survival benefit to the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to neoadjuvant chemotherapy (NACT) for stage III epithelial ovarian cancer (EOC). The objective of the current study was to quantify the cost-effectiveness of HIPEC in this setting. METHODS: A decision analytic cost-effectiveness model was designed from a payer perspective to compare 2 surgical management strategies for EOC: (1) interval cytoreductive surgery (ICS); (2) ICS + HIPEC. Overall survival and ostomy rates with HIPEC were modeled from published studies. We assumed that 25% of each arm would later undergo secondary cytoreductive surgery, with the ICS arm eligible for HIPEC at that time. Costs were obtained from Medicare data, published studies, and the financial department of an academic hospital. Quality of life was not different between the arms; we assigned utilities based on a prior time-trade off study of ovarian cancer treatment. A Monte Carlo probabilistic sensitivity analysis was performed in the base case; primary outcome was the incremental cost-effectiveness ratio (ICER), expressed in 2017 US Dollars/quality-adjusted life years (QALYs). RESULTS: ICS was the least costly strategy at $78,849, compared to ICS + HIPEC at $79,954. ICS + HIPEC was more effective than ICS (2.9 QALYs versus 2.45 QALYs for ICS). ICS + HIPEC was highly cost-effective, with an ICER of $2436/QALY compared to ICS. In one-way sensitivity analyses, probability of ostomy reversal and use of HIPEC at secondary cytoreduction did not substantially impact the cost-effectiveness of ICS + HIPEC. CONCLUSION: ICS + HIPEC constitutes cost-effective management of stage III EOC when NACT is performed.


Subject(s)
Carcinoma, Ovarian Epithelial/therapy , Hyperthermia, Induced/economics , Carcinoma, Ovarian Epithelial/drug therapy , Carcinoma, Ovarian Epithelial/economics , Carcinoma, Ovarian Epithelial/surgery , Chemotherapy, Adjuvant , Cost-Benefit Analysis , Cytoreduction Surgical Procedures/economics , Cytoreduction Surgical Procedures/methods , Decision Support Techniques , Female , Humans , Hyperthermia, Induced/methods , Neoadjuvant Therapy , Neoplasm Staging , Quality of Life , Randomized Controlled Trials as Topic , United States
9.
Ann Surg Oncol ; 26(4): 1110-1117, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30690682

ABSTRACT

BACKGROUND: Cost-effectiveness evaluations of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis (PC) from metastatic colorectal cancer (mCRC) in the United States are lacking. METHODS: The authors developed a Markov model to evaluate the cost-effectiveness of CRS/HIPEC compared with systemic chemotherapy for isolated PC from mCRC from a societal perspective in the United States. The systemic treatment regimens consisted of FOLFOX, FOLFIRI, bevacizumab, cetuximab, and pantitumumab. The model inputs including costs, probabilities, survival, progression, and utilities were taken from the literature. The cycle length for the model was 2 weeks, and the time horizon was 7 years. A discount rate of 3% was applied. The model was tested for internal and external validation, and robustness was established with univariate sensitivity and probabilistic sensitivity analyses (PSA). The primary outcomes were total costs, quality-adjusted life-years (QALYs), life-years (LYs), and incremental cost-effectiveness ratio (ICER). A willingness-to-pay (WTP) threshold of $100,000 per QALY was assumed. RESULTS: The ICER for treatment with CRS/HIPEC compared with systemic chemotherapy was $91,034 per QALY gained ($74,098 per LY gained). The univariate sensitivity analysis showed that the total costs for treatment with CRS/HIPEC had the largest effect on the calculated ICER. The CRS/HIPEC treatment was a cost-effective strategy during the majority of simulations in the PSA. The average ICER for 100,000 simulations in the PSA was $70,807 per QALY gained. The likelihood of CRS/HIPEC being a cost-effective strategy at the WTP threshold was 87%. CONCLUSIONS: The CRS/HIPEC procedure is a cost-effective treatment for isolated PC from mCRC in the United States.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/economics , Chemotherapy, Cancer, Regional Perfusion/economics , Colorectal Neoplasms/economics , Cytoreduction Surgical Procedures/economics , Hyperthermia, Induced/economics , Peritoneal Neoplasms/economics , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemotherapy, Cancer, Regional Perfusion/methods , Colorectal Neoplasms/pathology , Colorectal Neoplasms/therapy , Combined Modality Therapy , Cytoreduction Surgical Procedures/methods , Humans , Hyperthermia, Induced/methods , Markov Chains , Meta-Analysis as Topic , Peritoneal Neoplasms/secondary , Peritoneal Neoplasms/therapy , Prognosis , Survival Rate
12.
Ann Surg Oncol ; 25(8): 2340-2346, 2018 Aug.
Article in English | MEDLINE | ID: mdl-29948417

ABSTRACT

BACKGROUND: Peritoneal carcinomatosis from colorectal cancer is a stage 4 disease for which palliative chemotherapy has traditionally been considered the mainstay of treatment. Since the development of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by Sugarbaker, this combined method treatment has resulted in improved survival outcomes with acceptable morbidity for selected patients with peritoneal carcinomatosis. This study examined the cost effectiveness of CRS and HIPEC compared with palliative chemotherapy for patients with peritoneal carcinomatosis from colorectal cancer within the context of the Singaporean health care system. METHODS: A retrospective review of patients with peritoneal carcinomatosis from histologically proven colorectal cancer treated at the National Cancer Centre Singapore (NCCS) was conducted. RESULTS: The average cost of CRS and HIPEC per patient was S$83,680.26, and the median overall survival period was 47 months. The calculated cost per life year attained for a patient who underwent CRS and HIPEC was S$21,365.19 per life year. In comparison, the average cost of palliative chemotherapy was S$44,478.87, with a median overall survival of 9 months, and the calculated cost per life year attained for a patient in this treatment group was S$59,305.16 per life year. CONCLUSION: The findings show that CRS and HIPEC results in prolonged survival for selected patients with colorectal peritoneal carcinomatosis and a lower cost per life year attained than for the traditionally used palliative chemotherapy. It should logically be the preferred treatment of choice for selected patients with colorectal peritoneal metastasis.


Subject(s)
Chemotherapy, Cancer, Regional Perfusion/economics , Colorectal Neoplasms/economics , Cost-Benefit Analysis , Cytoreduction Surgical Procedures/economics , Hyperthermia, Induced/economics , Neoplasm Recurrence, Local/economics , Peritoneal Neoplasms/economics , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Colorectal Neoplasms/pathology , Colorectal Neoplasms/therapy , Combined Modality Therapy , Disease Management , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/therapy , Peritoneal Neoplasms/pathology , Peritoneal Neoplasms/therapy , Prognosis , Retrospective Studies , Survival Rate
13.
Eur J Surg Oncol ; 44(7): 983-990, 2018 07.
Article in English | MEDLINE | ID: mdl-29530346

ABSTRACT

BACKGROUND: The aim was to compare health-related quality-of-life (HRQOL) and cost-effectiveness between cytoreductive surgery with intraperitoneal chemotherapy (CRS + IPC) and systemic chemotherapy for patients with colorectal peritoneal metastases. METHODS: Patients included in the Swedish Peritoneal Trial comparing CRS + IPC and systemic chemotherapy completed the EORTC QLQ-C30 and SF-36 questionnaires at baseline, 2, 4, 6, 12, 18, and 24 months. HRQOL at 24 months was the primary endpoint. EORTC sum score, SF-36 physical and mental component scores at 24 months were calculated and compared for each arm and then referenced against general population values. Two quality-adjusted life-year (QALY) indices were applied (EORTC-8D and SF-6D) and an incremental cost-effectiveness ratio (ICER) per QALY gained was calculated. A projected life-time ICER per QALY gained was calculated using predicted survival according to Swedish population statistics. RESULTS: No statistical differences in HRQOL between the arms were noted at 24 months. Descriptively, survivors in the surgery arm had higher summary scores than the general population at 24 months, whereas survivors in the chemotherapy arm had lower scores. The projected life-time QALY benefit was 3.8 QALYs in favor of the surgery arm (p=0.06) with an ICER per QALY gained at 310,000 SEK (EORTC-8D) or 362,000 SEK (SF-6D) corresponding to 26,700-31,200 GBP. CONCLUSION: The HRQOL in patients with colorectal peritoneal metastases undergoing CRS + IPC appear similar to those receiving systemic chemotherapy. Two-year survivors in the CRS + IPC arm have comparable HRQOL to a general population reference. The treatment is cost-effective according to NICE guidelines.


Subject(s)
Antineoplastic Agents/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma/therapy , Colorectal Neoplasms/therapy , Cytoreduction Surgical Procedures/methods , Fluorouracil/administration & dosage , Hyperthermia, Induced/methods , Peritoneal Neoplasms/therapy , Quality of Life , Aged , Antineoplastic Agents/economics , Antineoplastic Combined Chemotherapy Protocols/economics , Carcinoma/physiopathology , Carcinoma/psychology , Carcinoma/secondary , Colorectal Neoplasms/pathology , Colorectal Neoplasms/physiopathology , Colorectal Neoplasms/psychology , Cost-Benefit Analysis , Cytoreduction Surgical Procedures/economics , Female , Fluorouracil/economics , Health Status , Humans , Hyperthermia, Induced/economics , Infusions, Parenteral , Male , Middle Aged , Organoplatinum Compounds/administration & dosage , Organoplatinum Compounds/economics , Oxaliplatin , Peritoneal Neoplasms/physiopathology , Peritoneal Neoplasms/psychology , Peritoneal Neoplasms/secondary , Quality-Adjusted Life Years
14.
Medicine (Baltimore) ; 97(10): e0042, 2018 Mar.
Article in English | MEDLINE | ID: mdl-29517660

ABSTRACT

Complications after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) result in impaired short- and long-term outcomes. However, financial consequences of complications after CRS and HIPEC in a European health care setting are unknown. This study aims to assess the consequences of complications on hospital costs after CRS and HIPEC.In this prospective observational cohort study, patients with colorectal peritoneal metastases treated with CRS and HIPEC were included. Financial information was collected according to the Dutch manual for costs analyses. Costs were compared between patients without complications (NC), minor complications (MC), or severe complications (SC), according to the Clavien-Dindo classification.One hundred and sixty-one patients were included, of whom 42% experienced NC, 27% MC and 31% SC. Mean hospital costs were &OV0556;9.406 ±â€Š2.235 in NC patients, &OV0556;12.471 ±â€Š3.893 in MC patients, and &OV0556;29.409 ±â€Š22.340 in SC patients. The 31% of patients with severe complications accounted for 56% of all hospital costs. Hospital admission costs in SC patients were 320% higher compared to NC patients. Costs of complications were estimated to be 43% of all admission costs.Severe postoperative complications have major influence on costs after CRS and HIPEC and result in a threefold increase of hospital costs in affected patients. This finding stresses the need for adequate risk assessment of developing severe complications after CRS and HIPEC.


Subject(s)
Colorectal Neoplasms/therapy , Cytoreduction Surgical Procedures/adverse effects , Hospital Costs/statistics & numerical data , Hyperthermia, Induced/adverse effects , Peritoneal Neoplasms/therapy , Postoperative Complications/economics , Adult , Aged , Cohort Studies , Colorectal Neoplasms/pathology , Cytoreduction Surgical Procedures/economics , Female , Humans , Hyperthermia, Induced/economics , Male , Middle Aged , Netherlands , Peritoneal Neoplasms/secondary , Prospective Studies
15.
BMC Public Health ; 18(1): 185, 2018 01 29.
Article in English | MEDLINE | ID: mdl-29378537

ABSTRACT

BACKGROUND: Cutaneous leishmaniasis causes a high disease burden in Colombia, and available treatments present systemic toxicity, low patient compliance, contraindications, and high costs. The purpose of this study was to estimate the cost-effectiveness of thermotherapy versus Glucantime in patients with cutaneous leishmaniasis in Colombia. METHODS: Cost-effectiveness study from an institutional perspective in 8133 incident cases. Data on therapeutic efficacy and safety were included, calculating standard costs; the outcomes were disability adjusted life years (DALYs) and the number of patients cured. The information sources were the Colombian Public Health Surveillance System, disease burden studies, and one meta-analysis of controlled clinical trials. Incremental cost-effectiveness was determined, and uncertainty was evaluated with tornado diagrams and Monte Carlo simulations. RESULTS: Thermotherapy would generate costs of US$ 501,621; the handling of adverse effects, US$ 29,224; and therapeutic failures, US$ 300,053. For Glucantime, these costs would be US$ 2,731,276, US$ 58,254, and US$ 406,298, respectively. With thermotherapy, the cost would be US$ 2062 per DALY averted and US$ 69 per patient cured; with Glucantime, the cost would be US$ 4241 per DALY averted and US$ 85 per patient cured. In Monte Carlo simulations, thermotherapy was the dominant strategy for DALYs averted in 67.9% of cases and highly cost-effective for patients cured in 72%. CONCLUSION: In Colombia, thermotherapy can be included as a cost-effective strategy for the management of cutaneous leishmaniasis. Its incorporation into clinical practice guidelines could represent savings of approximately US$ 10,488 per DALY averted and costs of US$ 116 per additional patient cured, compared to the use of Glucantime. These findings show the relevance of the incorporation of this treatment in our country and others with similar parasitological, clinical, and epidemiological patterns.


Subject(s)
Hyperthermia, Induced/economics , Leishmaniasis, Cutaneous/therapy , Colombia , Cost-Benefit Analysis , Disabled Persons/statistics & numerical data , Humans , Meglumine/economics , Meglumine/therapeutic use , Meglumine Antimoniate , Organometallic Compounds/economics , Organometallic Compounds/therapeutic use , Quality-Adjusted Life Years , Treatment Outcome
16.
BMJ Open ; 7(11): e017387, 2017 Nov 03.
Article in English | MEDLINE | ID: mdl-29102988

ABSTRACT

OBJECTIVE: To assess the efficacy and cost-effectiveness of modulated electrohyperthermia (mEHT) concurrent to dose-dense temozolomide (ddTMZ) 21/28 days regimen versus ddTMZ 21/28 days alone in patients with recurrent glioblastoma (GBM). DESIGN: A cohort of 54 patients with recurrent GBM treated with ddTMZ+mEHT in 2000-2005 was systematically retrospectively compared with five pooled ddTMZ 21/28 days cohorts (114 patients) enrolled in 2008-2013. RESULTS: The ddTMZ+mEHT cohort had a not significantly improved mean survival time (mST) versus the comparator (p=0.531) after a significantly less mean number of cycles (1.56 vs 3.98, p<0.001). Effect-to-treatment analysis (ETA) suggests that mEHT significantly enhances the efficacy of the ddTMZ 21/28 days regimen (p=0.011), with significantly less toxicity (no grade III-IV toxicity vs 45%-92%, p<0.0001). An estimated maximal attainable median survival time is 10.10 months (9.10-11.10). Cost-effectiveness analysis suggests that, unlike ddTMZ 21/28 days alone, ddTMZ+mEHT is cost-effective versus the applicable cost-effectiveness thresholds €US$25 000-50 000/quality-adjusted life year (QALY). Budget impact analysis suggests a significant saving of €8 577 947/$11 201 761 with 29.1-38.5 QALY gained per 1000 patients per year. Cost-benefit analysis suggests that mEHT is profitable and will generate revenues between €3 124 574 and $6 458 400, with a total economic effect (saving+revenues) of €5 700 034 to $8 237 432 per mEHT device over an 8-year period. CONCLUSIONS: Our ETA suggests that mEHT significantly improves survival of patients receiving the ddTMZ 21/28 days regimen. Economic evaluation suggests that ddTMZ+mEHT is cost-effective, budget-saving and profitable. After confirmation of the results, mEHT could be recommended for the treatment of recurrent GBM as a cost-effective enhancer of ddTMZ regimens, and, probably, of the regular 5/28 days regimen. mEHT is applicable also as a single treatment if chemotherapy is impossible, and as a salvage treatment after the failure of chemotherapy.


Subject(s)
Antineoplastic Agents, Alkylating/therapeutic use , Brain Neoplasms/therapy , Dacarbazine/analogs & derivatives , Glioblastoma/therapy , Hyperthermia, Induced/economics , Adult , Aged , Antineoplastic Agents, Alkylating/economics , Brain Neoplasms/economics , Cost-Benefit Analysis , Dacarbazine/economics , Dacarbazine/therapeutic use , Female , Germany , Glioblastoma/economics , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/therapy , Quality-Adjusted Life Years , Regression Analysis , Retrospective Studies , Temozolomide
17.
J Evid Based Med ; 10(2): 81-90, 2017 May.
Article in English | MEDLINE | ID: mdl-28276641

ABSTRACT

OBJECTIVE: The treatment of cutaneous leishmaniasis is toxic, has contraindications, and a high cost. The objective of this study was to estimate the cost-effectiveness of thermotherapy versus pentavalent antimonials for the treatment of cutaneous leishmaniasis. METHODS: Effectiveness was the proportion of healing and safety with the adverse effects; these parameters were estimated from a controlled clinical trial and a meta-analysis. A standard costing was conducted. Average and incremental cost-effectiveness ratios were estimated. The uncertainty regarding effectiveness, safety, and costs was determined through sensitivity analyses. RESULTS: The total costs were $66,807 with Glucantime and $14,079 with thermotherapy. The therapeutic effectiveness rates were 64.2% for thermotherapy and 85.1% for Glucantime. The average cost-effectiveness ratios ranged between $721 and $1275 for Glucantime and between $187 and $390 for thermotherapy. Based on the meta-analysis, thermotherapy may be a dominant strategy. CONCLUSION: The excellent cost-effectiveness ratio of thermotherapy shows the relevance of its inclusion in guidelines for the treatment.


Subject(s)
Antiprotozoal Agents/economics , Hyperthermia, Induced/economics , Leishmaniasis, Cutaneous/therapy , Antiprotozoal Agents/adverse effects , Antiprotozoal Agents/therapeutic use , Cost-Benefit Analysis , Drug Costs , Humans , Hyperthermia, Induced/adverse effects , Uncertainty
18.
Phlebology ; 31(1 Suppl): 80-7, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26916774

ABSTRACT

Varicose veins affect one-quarter to one-third of Western adult populations and consume an increasing amount of health care resources. Much of this increased utilization has been driven by the advent of minimally invasive technology including endovenous thermal ablation, foam sclerotherapy, and more recently mechanicochemical and cyanoacrylate glue ablation. This has largely been driven by patient and physician preferences in the absence of robust evidence that one therapy is truly superior to another. This partially arises from misunderstandings about appropriate outcomes measures and what truly constitutes effective treatment of varicose veins. Technical outcomes, such as saphenous closure rates, have frequently been used as surrogates for effective treatment but are poorly correlated with symptom improvement, quality of life, and risk of recurrence. Although there does appear to be a trend towards higher recurrence with ultrasound-guided foam sclerotherapy, the data are occasionally conflicting and there does not appear to be substantial differences between the various modalities. Similarly, there do not appear to be major differences in late quality of life measures between these treatment options. As long-term differences in recurrence and quality of life are small, overall cost effectiveness is driven primarily by initial treatment costs and ultrasound-guided foam sclerotherapy is the most cost-effective strategy in many models. However, there continues to be substantial uncertainty surrounding cost estimates and other factors of importance to the patient may ultimately drive treatment decisions. The benefits of some adjuncts to the treatment of axial superficial reflux, such as the concurrent versus staged management of tributary varicosities, remain ill-defined while that of others, such as routine post-procedural ultrasound surveillance and compression, need critical re-evaluation.


Subject(s)
Endovascular Procedures , Hyperthermia, Induced , Quality of Life , Sclerotherapy , Varicose Veins , Adult , Costs and Cost Analysis , Endovascular Procedures/economics , Endovascular Procedures/methods , Female , Humans , Hyperthermia, Induced/economics , Hyperthermia, Induced/methods , Male , Recurrence , Risk Factors , Sclerotherapy/economics , Sclerotherapy/methods , Varicose Veins/economics , Varicose Veins/therapy
19.
J Surg Oncol ; 113(5): 544-7, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26750613

ABSTRACT

BACKGROUND: The combination of Cytoreductive Surgery (CRS) plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has been gaining a considerable interest by surgeons throughout the United States due to the significant survival improvement it provides for peritoneal surface malignancies and the ability to reproduce comparable clinical results in numerous health care centers. However, CRS plus HIPEC has not been sufficiently investigated from the economic standpoint in the United States where a wide variety of health care insurers exists. This study was conducted to analyze hospital/surgeon cost and reimbursement data at a community hospital offering a new peritoneal surface malignancy program, and expand the discussion to analyze future healthcare implementation on this procedure in the United States. METHODS: This is a retrospective economic analysis of an initial CRS plus HIPEC experience at a community non-teaching medical center. This study was conducted using hospital/surgeon cost and reimbursement based on the Office of Finance data at Edward Hospital Cancer Center (Naperville, IL). All patients who underwent CRS and HIPEC between June 2013 and August 2014 were included in this analysis. We aimed to assess CRS plus HIPEC purely from the financial perspective on the initial admission regardless of the patients' advancement of the disease or postoperative adverse events. RESULTS: Twenty-five patients underwent 26 CRS plus HIPEC procedures. Twelve patients had private insurance plans (PRV) whereas 13 were covered by public insurers (PUB). Median overall length of stay (LOS) was 10 days (PRV 10 days vs. PUB 11 days; P = 0.76.) Average hospital cost was $38,369 (PRV $37,093 vs. PUB $39,463; P = 0.67), and average reimbursement for our patient population was $45,243 (PRV $48,954 vs. PUB $42,062; P = 0.53). It was noted that CRS plus HIPEC generated more net profit in patients with private insurance than in those with public plans, however, not statistically significant ($11,861 vs. $2,599 per patient, respectively; P = 0.38). Evaluating surgeon's data, average surgeon's charge was $29,139 (PRV $28,440 vs. PUB $29,737; P = 0.80), and average patients' payment was $8,126 (PRV 9,234 vs. PUB 7,176; P = 0.47). CONCLUSION: CRS plus HIPEC is profitable in the community setting for both the hospital and surgeon. Both private and public insurers reimbursed profitably, though with a greater profit margin from private insurers. As CRS plus HIPEC is becoming more widely recognized as a standard of care for patients with peritoneal surface malignancy, it is increasingly important to understand and report its associated costs and variability in insurance coverage, especially in light of the current healthcare structure changes in the United States. It is strongly encouraged to report and present a wider scope of CRS plus HIPEC economic experiences in a variety of hospital settings to provide further evidence for future healthcare implementations in the United States. J. Surg. Oncol. 2016;113:544-547. © 2016 Wiley Periodicals, Inc.


Subject(s)
Chemotherapy, Cancer, Regional Perfusion/economics , Cytoreduction Surgical Procedures/economics , Hospital Costs , Hyperthermia, Induced/economics , Peritoneal Neoplasms/therapy , Reimbursement Mechanisms/economics , Adult , Aged , Combined Modality Therapy/economics , Cost-Benefit Analysis , Female , Hospitals, Community/economics , Humans , Length of Stay/economics , Male , Middle Aged , Peritoneal Neoplasms/economics , Retrospective Studies , United States
20.
Eur J Surg Oncol ; 41(3): 386-91, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25554680

ABSTRACT

BACKGROUND: Malignancies of the peritoneum remain a challenge in any hospital that accepts to manage them, due not only to difficulties associated with the complexity of the procedures involved but also the costs, which - in Italy and other countries that use a diagnosis-related group (DRG) system - are not adequately reimbursed. MATERIAL AND METHODS: We analyzed data relative to 24 patients operated on between September 2010 and May 2013 with special regard to operating room expenditure, ICU stay, duration of hospitalization, and DRG reimbursement. The total costs per patient included clinical, operating room, procedure, pathology, imaging, ward care, allied healthcare, pharmaceutical, and ICU costs. RESULTS: Postoperative hospital stay, drugs and materials, and operating room occupancy were the main factors affecting the expenditure for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. We had a median hospitalization of 14 days, median ICU stay of 2.4 days, and median operating room occupancy of 585 min. The median expenditure for each case was € 21,744; the median reimbursement by the national health system € 8,375. CONCLUSIONS: In a DRG reimbursement system, the economic effort in the management of patients undergoing peritonectomy procedures may not be counterbalanced by adequate reimbursement. Joint efforts between medical and administration parties are mandatory to develop appropriate treatment protocols and keep down the costs.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/economics , Carcinoma/economics , Colorectal Neoplasms/economics , Health Care Costs , Hyperthermia, Induced/economics , Mesothelioma/economics , Neoplasms, Glandular and Epithelial/economics , Ovarian Neoplasms/economics , Peritoneal Neoplasms/economics , Pseudomyxoma Peritonei/economics , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma/secondary , Carcinoma/therapy , Carcinoma, Ovarian Epithelial , Cohort Studies , Colorectal Neoplasms/pathology , Costs and Cost Analysis , Critical Care/economics , Cytoreduction Surgical Procedures/economics , Diagnosis-Related Groups/economics , Female , Hospitalization/economics , Humans , Infusions, Parenteral/economics , Italy , Length of Stay/economics , Male , Mesothelioma/secondary , Mesothelioma/therapy , Middle Aged , Neoplasms, Glandular and Epithelial/pathology , Operative Time , Ovarian Neoplasms/pathology , Peritoneal Neoplasms/secondary , Peritoneal Neoplasms/therapy , Peritoneum/surgery , Pseudomyxoma Peritonei/therapy , Surgical Procedures, Operative/economics
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