The Role of Cost-Effectiveness Analysis for Patient-Centered Cancer Care in the Era of Precision Medicine

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: closed (20 May 2022) | Viewed by 21869

Special Issue Editors

Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Interests: Cancer imaging, Molecular imaging, Parathyroid diseases
Montefiore Medical Center, New York, NY, USA
Interests: Health care policy; Health care sustainability; Health economics

Special Issue Information

Dear Colleagues,

Over the last few decades, the cost of cancer care has been constantly increasing. While changes in diagnostic and treatment paradigms have advanced cancer care and improved outcomes through precision medicine, appropriate resource allocation and determining the effectiveness of cancer care are priorities for ensuring sustainable healthcare systems. Additionally, cost-effectiveness metrics can be used as tools to allow for patient-centered care by providing patients objective metrics for each treatment strategy so that they can have an active role in the decision process. Hence, there is a critical need to implement cost-effectiveness analyses to inform healthcare decisions in clinical practice. Of note, controlling expenditure is a multifaceted challenge involving a wide range of variables. For example, healthcare spending has mostly increased due to increased drug costs, but there are several other contributing factors such as failure of screening programs, increased cancer prevalence, increased staff cost, legal costs, and facility fees. In this Special Issue, we seek innovative comparative and cost-effectiveness analysis studies to guide cancer management decisions and health policy. In a wide range of indications, several technologies and treatments achieve similar performance and the clinical decision is based upon subjective criteria. Therefore, this topic aims to share new frameworks and concepts to determine the most cost-effective diagnostic and treatment strategies to maximize the care of cancer patients and resource utilization.

Dr. Laurent Dercle
Dr. Randy Yeh
Dr. Fabrizio Toscano
Guest Editors

Manuscript Submission Information

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Keywords

  • Cost-effectiveness
  • Patient-centered care
  • Precision medicine

Published Papers (9 papers)

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Editorial

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7 pages, 575 KiB  
Editorial
The Role of Cost-Effectiveness Analysis in Patient-Centered Cancer Care in the Era of Precision Medicine
by Fabrizio Toscano, Alberto Vera, Eleanor Kim, Davide Golinelli, Helena Vila-Reyes, Fernand Bteich, Antoine Schernberg, Romain-David Seban, Randy Yeh and Laurent Dercle
Cancers 2021, 13(17), 4272; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13174272 - 25 Aug 2021
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Abstract
Over the last few decades, changes in diagnostic and treatment paradigms have greatly advanced cancer care and improved outcomes [...] Full article
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Research

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12 pages, 909 KiB  
Article
Cost-Effectiveness of an Organized Lung Cancer Screening Program for Asbestos-Exposed Subjects
by Sébastien Gendarme, Jean-Claude Pairon, Pascal Andujar, François Laurent, Patrick Brochard, Fleur Delva, Bénédicte Clin, Antoine Gislard, Christophe Paris, Isabelle Thaon, Helene Goussault, Florence Canoui-Poitrine and Christos Chouaïd
Cancers 2022, 14(17), 4089; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14174089 - 24 Aug 2022
Cited by 1 | Viewed by 1441
Abstract
Background: The National Lung Screening Trial (NLST) and NELSON study opened the debate on the relevance of lung cancer (LC) screening in subjects exposed to occupational respiratory carcinogens. This analysis reported the incremental cost-effectiveness ratios (ICER) of an organized LC screening program [...] Read more.
Background: The National Lung Screening Trial (NLST) and NELSON study opened the debate on the relevance of lung cancer (LC) screening in subjects exposed to occupational respiratory carcinogens. This analysis reported the incremental cost-effectiveness ratios (ICER) of an organized LC screening program for an asbestos-exposed population. Methods: Using Markov modelization, individuals with asbestos exposure were either monitored without intervention or annual low-dose thoracic computed-tomography (LDTCT) scan LC screening. LC incidence came from a prospective observational cohort of subjects with occupational asbestos exposure. The intervention parameters were those of the NLST study. Utilities and LC-management costs came from published reports. A sensitivity analysis evaluated different screening strategies. Results: The respective quality-adjusted life year (QALY) gain, supplementary costs and ICER [95% confidence interval] were: 0.040 [0.010–0.065] QALY, 6900 [3700–11,800] € and 170,000 [75,000–645,000] €/QALY for all asbestos-exposed subjects; and 0.144 [0.071–0.216] QALY, 13,000 [5700–26,800] € and 90,000 [35,000–276,000] €/QALY for smokers with high exposure. When screening was based on biennial LDTCT scans, the ICER was 45,000 [95% CI: 15,000–116,000] €/QALY. Conclusions: Compared to the usual ICER thresholds, biennial LDTCT scan LC screening for smokers with high occupational exposure to asbestos is acceptable and preferable to annual scans. Full article
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12 pages, 1483 KiB  
Article
Treatment Costs of Colorectal Cancer by Sex and Age: Population-Based Study on Health Insurance Data from Germany
by Thomas Heisser, Andreas Simon, Jana Hapfelmeier, Michael Hoffmeister and Hermann Brenner
Cancers 2022, 14(15), 3836; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14153836 - 08 Aug 2022
Cited by 6 | Viewed by 1837
Abstract
Objective: Evidence on the cost-effectiveness of screening for colorectal cancer (CRC) in the German general population remains scarce as key input parameters, the costs to treat CRC, are largely unknown. Here, we provide detailed estimates on CRC treatment costs over time. Methods: Using [...] Read more.
Objective: Evidence on the cost-effectiveness of screening for colorectal cancer (CRC) in the German general population remains scarce as key input parameters, the costs to treat CRC, are largely unknown. Here, we provide detailed estimates on CRC treatment costs over time. Methods: Using insurance claims data from the Vilua healthcare research database, we included subjects with newly diagnosed CRC and subjects who died of CRC between 2012 and 2016. We assessed annualized CRC-related inpatient, outpatient and medication costs for up to five years after first diagnosis and prior to death, stratified by sex and age. Findings: We identified 1748 and 1117 subjects with follow-up data for at least 1 year after diagnosis and prior to death, respectively. In those newly diagnosed, average costs were highest in the first year after diagnosis (men, EUR 16,375–16,450; women, EUR 10,071–13,250) and dropped steeply in the following years, with no consistent pattern of differences with respect to age. Costs prior to death were substantially higher as compared to the initial phase of care and consistently on a high level even several years before death, peaking in the final year of life, with strong differences by sex and age (men vs. women, <70 years, EUR 34,351 vs. EUR 31,417; ≥70 years, EUR 14,463 vs. EUR 9930). Conclusion: Once clinically manifest, CRC causes substantial treatment costs over time, particularly in the palliative care setting. Strong differences in treatment costs by sex and age warrant further investigation. Full article
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8 pages, 235 KiB  
Article
The Cost of Enfortumab Vedotin Wastage Due to Vial Size—A Real-World Analysis
by Michal Sarfaty, Assaf Moore, Ashley M. Regazzi, Aaron P. Mitchell and Jonathan E. Rosenberg
Cancers 2021, 13(23), 5977; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13235977 - 27 Nov 2021
Cited by 1 | Viewed by 2852
Abstract
Enfortumab Vedotin (EV) is FDA-approved for advanced urothelial cancer in patients previously treated with platinum-based chemotherapy and a checkpoint inhibitor. We conducted a real-world study to determine the extent of EV wastage in a single institution and assessed the financial impact of EV [...] Read more.
Enfortumab Vedotin (EV) is FDA-approved for advanced urothelial cancer in patients previously treated with platinum-based chemotherapy and a checkpoint inhibitor. We conducted a real-world study to determine the extent of EV wastage in a single institution and assessed the financial impact of EV wastage annually in the United States. Systematic examination of the usage and wastage of all standard-of-care EV treatments administered to urothelial cancer patients at Memorial Sloan Kettering Cancer Center (MSKCC) between 1 January 2020 and 31 December 2020 was performed. Drug wastage was calculated by subtracting the actual administered dose from the total dose in an optimal set of vials. We built a pharmacoeconomic model to assess the financial impact of EV wastage annually in the US using the January 2021 Average Sales Prices from the Centers for Medicare and Medicaid Services. Sixty-four patients were treated with standard-of-care EV, with a median of 11 doses per patient (range 1–28). Wastage occurred in 46% of administered doses (367/793), with a mean waste per dose of 2.9% (0–18%). The average drug wastage cost per patient was $3127 ($252/dose). The annual cost of EV wastage in the US is estimated to be $15 million based on wastage data from a single center in the US. In summary, EV wastage due to available vial sizes was 2.9%, which falls under acceptable thresholds. While the percentage of EV wastage is relatively low, waste-minimizing practices may reduce the financial toxicity for the individual patient and for society. Full article
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13 pages, 809 KiB  
Article
Development of Population-Based Cancer Indicators and a Measurement of Cancer Care Continuum Using a Modified Delphi Method
by Vasuki Rajaguru, Jieun Jang, JaeHyun Kim, JeoungA Kwon, Oyeon Cho, SeungYeun Chung, MiSun Ahn, JinHee Park, YoungJoo Won, KyuWon Jung, Jaeyong Shin and Mison Chun
Cancers 2021, 13(19), 4826; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13194826 - 27 Sep 2021
Cited by 3 | Viewed by 2542
Abstract
To identify population-based cancer indicators and construct monitoring systems for the entire lifecycle of cancer patients using a modified Delphi method. A modified Delphi method was used to identify the cancer indicators and measurement by scoping review and gray literature. The final list [...] Read more.
To identify population-based cancer indicators and construct monitoring systems for the entire lifecycle of cancer patients using a modified Delphi method. A modified Delphi method was used to identify the cancer indicators and measurement by scoping review and gray literature. The final list of cancer indicators was developed by consensus of 11 multidisciplinary experts over multiple rounds and rating scored the importance of each indicator on a 10-point scale. Frequency analysis was performed to rate with median scores ≥7 and finalized the list of indicators according to the priority. Initially, 254 indicators were identified, of which 94 were considered important and feasible. After two rounds of rating by the experts and panel discussions, 26 indicators were finalized in six domains: primary prevention (n = 7), secondary prevention (n = 11), treatment (n = 2), quality of life (n = 4), survivor management (n = 1), and end-of-life care (n = 1). The Donabedian model used for examining health services and the Institute of Medicine quality of healthcare domains were applied to the measurement system. Panel experts identified cancer indicators based on priorities with a high level of consensus, providing a scrupulous foundation for community-based monitoring of cancer patients. Full article
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Review

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14 pages, 824 KiB  
Review
The Economic Burden of Localized Prostate Cancer and Insights Derived from Cost-Effectiveness Studies of the Different Treatments
by David Cantarero-Prieto, Javier Lera, Paloma Lanza-Leon, Marina Barreda-Gutierrez, Vicente Guillem-Porta, Luis Castelo-Branco and Jose M. Martin-Moreno
Cancers 2022, 14(17), 4088; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14174088 - 24 Aug 2022
Cited by 3 | Viewed by 2358
Abstract
Prostate cancer has huge health and societal impacts, and there is no clear consensus on the most effective and efficient treatment strategy for this disease, particularly for localized prostate cancer. We have reviewed the scientific literature describing the economic burden and cost-effectiveness of [...] Read more.
Prostate cancer has huge health and societal impacts, and there is no clear consensus on the most effective and efficient treatment strategy for this disease, particularly for localized prostate cancer. We have reviewed the scientific literature describing the economic burden and cost-effectiveness of different treatment strategies for localized prostate cancer in OECD countries. We initially identified 315 articles, studying 13 of them in depth (those that met the inclusion criteria), comparing the social perspectives of cost, time period, geographical area, and severity. The economic burden arising from prostate cancer due to losses in productivity and increased caregiver load is noticeable, but clinical decision-making is carried out with more subjective variability than would be advisable. The direct cost of the intervention was the main driver for the treatment of less severe cases of prostate cancer, whereas for more severe cases, the most important determinant was the loss in productivity. Newer, more affordable radiotherapy strategies may play a crucial role in the future treatment of early prostate cancer. The interpretation of our results depends on conducting thorough sensitivity analyses. This approach may help better understand parameter uncertainty and the methodological choices discussed in health economics studies. Future results of ongoing clinical trials that are considering genetic characteristics in assessing treatment response of patients with localized prostate cancer may shed new light on important clinical and pharmacoeconomic decisions. Full article
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26 pages, 507 KiB  
Review
Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review
by Sara Zuccarino, Fiammetta Monacelli, Rachele Antognoli, Alessio Nencioni, Fabio Monzani, Francesca Ferrè, Chiara Seghieri and Raffaele Antonelli Incalzi
Cancers 2022, 14(13), 3235; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14133235 - 30 Jun 2022
Cited by 7 | Viewed by 2258
Abstract
The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical [...] Read more.
The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical outcomes and in cost-effectiveness remains to be fully established, and CGA is still far from being routinely implemented in geriatric oncology. This narrative review aims to analyse the available evidence on the cost-effectiveness of CGA adopted in geriatric oncology, identify the relevant parameters used in the literature and provide recommendations for future research. The review was conducted using the PubMed and Cochrane databases, covering published studies without selection by the publication year. The extracted data were categorised according to the study design, participants and measures of cost-effectiveness, and the results are summarised to state the levels of evidence. The review conforms to the SANRA guidelines for quality assessment. Twenty-nine studies out of the thirty-seven assessed for eligibility met the inclusion criteria. Although there is a large heterogeneity, the overall evidence is consistent with the measurable benefits of CGA in terms of reducing the in-hospital length of stay and treatment toxicity, leaning toward a positive cost-effectiveness of the interventions and supporting CGA implementation in geriatric oncology clinical practice. More research employing full economic evaluations is needed to confirm this evidence and should focus on CGA implications both from patient-centred and healthcare system perspectives. Full article
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19 pages, 4283 KiB  
Review
Economic Perspective of Cancer Care and Its Consequences for Vulnerable Groups
by Joerg Haier and Juergen Schaefers
Cancers 2022, 14(13), 3158; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14133158 - 28 Jun 2022
Cited by 13 | Viewed by 2523
Abstract
Within healthcare systems in all countries, vulnerable groups of patients can be identified and are characterized by the reduced utilization of available healthcare. Many different reasons can be attributed to this observation, summarized as implementation barriers involving acceptance, accessibility, affordability, acceptability and quality [...] Read more.
Within healthcare systems in all countries, vulnerable groups of patients can be identified and are characterized by the reduced utilization of available healthcare. Many different reasons can be attributed to this observation, summarized as implementation barriers involving acceptance, accessibility, affordability, acceptability and quality of care. For many patients, cancer care is specifically associated with the occurrence of vulnerability due to the complex disease, very different target groups and delivery situations (from prevention to palliative care) as well as cost-intensive care. Sociodemographic factors, such as educational level, rural/remote location and income, are known determinants for these vulnerable groups. However, different forms of financial burdens likely influence this vulnerability in cancer care delivery in a distinct manner. In a narrative review, these socioeconomic challenges are summarized regarding their occurrence and consequences to current cancer care. Overall, besides direct costs such as for treatment, many facets of indirect costs including survivorship costs for the cancer patients and their social environment need to be considered regarding the impact on vulnerability, treatment compliance and abundance. In addition, individual cancer-related financial burden might also affect the society due to the loss of productivity and workforce availability. Healthcare providers are requested to address this vulnerability during the treatment of cancer patients. Full article
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Other

17 pages, 1561 KiB  
Systematic Review
Uptake Rates of Risk-Reducing Surgeries for Women at Increased Risk of Hereditary Breast and Ovarian Cancer Applied to Cost-Effectiveness Analyses: A Scoping Systematic Review
by Julia Simões Corrêa Galendi, Sibylle Kautz-Freimuth, Stephanie Stock and Dirk Müller
Cancers 2022, 14(7), 1786; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14071786 - 31 Mar 2022
Cited by 7 | Viewed by 1954
Abstract
The cost-effectiveness of genetic screen-and-treat strategies for women at increased risk for breast and ovarian cancer often depends on the women’s willingness to make use of risk-reducing mastectomy (RRM) or salpingo-oophorectomy (RRSO). To explore the uptake rates of RRM and RRSO applied in [...] Read more.
The cost-effectiveness of genetic screen-and-treat strategies for women at increased risk for breast and ovarian cancer often depends on the women’s willingness to make use of risk-reducing mastectomy (RRM) or salpingo-oophorectomy (RRSO). To explore the uptake rates of RRM and RRSO applied in health economic modeling studies and the impact of uptake rates on the incremental cost-effectiveness ratios (ICER), we conducted a scoping literature review. In addition, using our own model, we conducted a value of information (VOI) analysis. Among the 19 models included in the review, the uptake rates of RRM ranged from 6% to 47% (RRSO: 10% to 88%). Fifty-seven percent of the models applied retrospective data obtained from registries, hospital records, or questionnaires. According to the models’ deterministic sensitivity analyses, there is a clear trend that a lower uptake rate increased the ICER and vice versa. Our VOI analysis showed high decision uncertainty associated with the uptake rates. In the future, uptake rates should be given more attention in the conceptualization of health economic modeling studies. Prospective studies are recommended to reflect regional and national variations in women’s preferences for preventive surgery. Full article
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