Health expenditure and socio-economic determinants of life expectancy in the OECD Asia/Pacific area countries

Recent economic research is focused on the study of the relationship between socio-economic factors and health outcomes. In this study, the relationship in the OECD Asia/Pacific area countries regarding life expectancy is explored. Data from the World Bank and OECD Health Statistics (2015) have been used to build a panel data during the period 1995–2013. On the one hand, it was found that per capita income, unemployment and exchange rates improve health outcomes. On the other hand, poor performance, in terms of government expenditures for the countries-sample, comes across. Empirical results highlight the importance of cost-effectiveness analysis.     

Overall survival,costs, and healthcare resource use by line of therapy in Medicare patients with newly diagnosed metastatic urothelial carcinoma

Aims: Medicare patients with metastatic or surgically unresectable urothelial carcinoma (mUC) often receive platinum-based chemotherapy as first line of therapy (LOT), but invariably progress, requiring additional LOTs and healthcare resource use (HCRU). To better understand the evolving mUC treatment landscape, the economic burden of chemotherapy-based mUC treatments among US Medicare patients was estimated.

Methods: Newly diagnosed Medicare patients with mUC were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Patients were followed from diagnosis to death, disenrollment, or end of study to characterize LOTs (first [LOT1], second [LOT2], and third or greater [LOT3+]). Kaplan-Meier methods were used to estimate overall survival (OS) by LOT. HCRU and mean costs were reported over the follow-up period, LOT duration, and maximum LOT received.

Results: Among 1,873 eligible patients with mUC (median age?=?77?years; median follow-up?=?7.5?months), 1,035 (55%) received no chemotherapy. Among chemotherapy-treated patients, 61% had LOT1 only, 25% had LOT1 and LOT2 only, and 14% had LOT3+. Median OS was 8.1?months, range was 4.3 (untreated) to 29.8 (LOT3+) months. HCRU frequency increased with additional LOTs. Mean cumulative per-patient cost was $82,912 for all patients, increasing with additional LOTs (untreated?=?$57,207; LOT1?=?$99,213; LOT2?=?$125,190; LOT3+?=?$163,884). Mean per patient per month cost was $18,827 for all patients, decreasing with increasing number of LOTs received (untreated?=?$27,211; LOT1?=?$9,601; LOT2?=?$7,325; LOT3+?=?$6,017).

Limitations: Potential for treatment misclassification when using the algorithm defining LOTs and non-generalizability of results to younger patients.

Conclusions: Over 50% of Medicare patients with mUC received no chemotherapy. Among chemotherapy-treated patients, most received only one LOT. Additional LOTs led to higher mean costs and HCRU, but as patients were followed longer, monthly costs decreased. As treatments evolve to include immuno-oncology agents, these findings provide a clinically relevant economic benchmark for mUC treatment across different traditional LOTs.     

Final development and validation of the BOMET-QoL questionnaire for assessing quality of life in patients with malignant bone disease due to neoplasia

SUMMARY

This paper describes the final development and validation of the BOMET-QoL questionnaire for assessing health-related quality of life (HRQoL) in patients with malignant bone disease due to neoplasia (MBDN).

An observational prospective study was conducted of 263 patients with MBDN. Sociodemographic and clinical variables, Eastern Cooperative Oncology Group (ECOG) Performance Scale Index and Pain Management Index (PMI) were gathered. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and BOMET-QoL questionnaires and the perception of general health status. Both questionnaires were completed again 15 days after the baseline visit by 98 clinically stable patients (Group A), and 3 months and 6 months after the baseline visit by 165 clinically unstable patients (Group B). Prior to validation of the BOMETQoL questionnaire, a factor analysis and psychometric selection of the original items was developed by means of Rasch analysis.

The BOMET-QoL questionnaire consisting of 25 items was reduced to an integrated version of 10 items. Scores on the BOMET-QoL-10 questionnaire were shown to be related to the presence, number and duration of irruptive pain crises, the PMI and the ECOG index (p<0.001), and with changes in the perception of general health status and ECOG index (p<0.01). The internal consistency of the questionnaire and the intraclass correlation coefficient (ICC) were high (Cronbach's α=0.93; ICC =0.97). BOMET-QoL-10 is an easy to manage and valid questionnaire in clinical practice conditions.