To calculate cost-effectiveness and cost-utility ratios for adjuvant postmastectomy locoregional radiotherapy in premenopausal node-positive breast cancer patients and to place these ratios in the context of generally accepted medical expenditures.
A spreadsheet-based activity costing model using 1997 Canadian (cdn) capital, operating, and administrative costs has been used to identify, from the institutional perspective, the incremental cost of adding radiotherapy to surgery and chemotherapy for this group of patients. Outcome data were derived from two recently published clinical trials and were converted to discounted incremental life years and quality-adjusted life years gained. Recommended health economics principles were employed in the quantification of both costs and outcomes, and a sensitivity analysis was performed. Three referenced publications provide a context within which to evaluate the calculated cost-effectiveness and cost-utility ratios.
The incremental cost of adjuvant radiotherapy for this group of patients is calculated to be approximately $7,000cdn in 1997 Canadian dollars and in the Canadian socialized health-care environment. Based on published work the discounted incremental outcome benefit is calculated to be 0.5 life years or 0.45 quality-adjusted life years at ten years. Thus, cost effectiveness and cost-utility ratios are estimated to be $14,000cdn and $15,600cdn, respectively.
Within the context of generally accepted medical expenditures, adjuvant postmastectomy locoregional radiotherapy for premenopausal node-positive breast cancer patients would be regarded as a cost-effective treatment strategy.
Comment In: Int J Radiat Oncol Biol Phys. 2001 Aug 1;50(5):137611503614
To assess the cost savings if the current policy of treating patients with a MACIS (metastases, age, completeness of resection, invasion, and size) score lower than 6 using radioactive iodine (RAI) was changed to reflect the findings of recent studies.
Retrospective medical record review.
Mount Sinai Hospital, Toronto, Ontario.
Between January 1, 2002, and July 1, 2005, 199 consecutive patients with a MACIS score lower than 6 who received RAI treatment after total thyroidectomy.
Patient demographics were analyzed. Costs for the dose of RAI, hospital stay, and health insurance claims were included in the calculations.
For 199 consecutive patients, the cost for sodium iodide 131 treatment totaled Can$161 588, and the required 2-day stay in isolation totaled Can$764 558. The overall cost to the health care system was Can$934 106, which translates into approximately Can$4694 per patient.
By following the recommendations of recent evidence-based studies and by ceasing to treat patients with a MACIS score lower than 6 after total thyroidectomy using RAI, cost savings can be accrued for health care systems involved in the treatment of thyroid cancer. Alternate strategies, such as treating patients who need RAI therapy on an outpatient basis and reducing the dose of RAI, can lower costs as well.
Patients with breast cancer incur out-of-pocket costs when they receive adjuvant radiation. These treatments are administered in dedicated centers on a daily basis over 4 to 5 weeks. We assessed the extent of out-of-pocket costs to access radiotherapy and identified women at risk of experiencing higher costs.
This prospective study was conducted among 800 women from eight Quebec hospitals (participation, 86%), of whom 693 women received adjuvant radiotherapy. Costs to access treatment (transportation, parking, lodging, and meals) were estimated on the basis of information collected by telephone interviews. Generalized linear models were used to identify women at risk of having higher costs.
Mean and median total costs (including financial aid received) to access radiotherapy were 445 Canadian dollars (Can$; standard deviation, Can$407) and Can$311, respectively. Women who lived at home but far from the radiotherapy center had the highest risk of experiencing weekly costs of at least Can$122 (highest quartile; prevalence ratio [PR], 5.8; 95% CI, 4.7 to 7.1) followed by women who lived away from home and farther from the center (PR, 4.5; 95% CI, 3.4 to 6.0) and by women who lived away from home and closer to the center (PR, 2.14; 95% CI, 1.3 to 3.5). When women stayed at a cancer lodge during treatment, costs were reduced by 80%.
Considered in and of themselves, out-of-pocket costs for access to radiotherapy appeared relatively modest. Financial assistance initiatives for women who lived away from home during treatments contributed to a substantial reduction of access costs. These efforts should be maintained, but financial assistance should also target patients with cancer who live at home during treatments but have to travel relatively long distances on a daily basis.
The study was concerned with efficacy and tolerability of radiochemotherapy for inoperable non-small cell lung cancer using fractionated single focal dose of radiation in conjunction with vinorelbine or 5-fluorouracil. The treatment proved moderately toxic and was frequently followed by complete regression and survival lasting 12-36 months. Also, it was cost-effective due to shorter courses of radiotherapy.