Cost of managing constipation among terminally ill cancer patients treated with transdermal fentanyl and 12 hour sustained-release morphine in Canada

Summary

This study examined the cost of treating constipation among terminally ill cancer patients receiving transdermal fentanyl and 12 hour sustained-release morphine in Ontario, Canada. A decision tree was constructed that modelled the treatment paths and associated resource use attributable to managing constipation among patients receiving both opioids using a randomised clinical trial and information on patient management obtained from a panel of eight physicians and two community nurses who specialise in palliative care in Ontario. The cost to the Ontario Ministry of Health of managing constipation in a patient receiving transdermal fentanyl and 12 hour sustained-release morphine was estimated to be $31.77 and $52.76 respectively during the first two weeks of treatment. When the opioids' acquisition costs were included, the two-weekly cost of managing a patient with transdermal fentanyl and 12 hour sustained-release morphine was $123.24 and $119.70 respectively. The results were sensitive to the incidence of constipation attributable to each opioid, the rate and length of hospital admission and the efficacy of various treatments for constipation. We conclude that opioid acquisition costs alone should not dictate treatment choice for palliative care, but attention should also be paid to the costs of managing opioid-related adverse events and care should always be tailored to the needs and preferences of individual patients.     

Cost-effectiveness of oxaliplatin in combination with 5-FU/FA compared with 5-FU/FA alone

SUMMARY

We performed a cost-effectiveness analysis to assess the cost-effectiveness of oxaliplatin in combination with 5-fluorouracil (5-FU) and folinic acid (FA), compared with 5-FU/FA alone to achieve an additional progression-free month or year from the UK NHS perspective. Clinical data from a Phase III clinical trial were used to determine efficacy, in terms of progression-free survival. The average drug-acquisition cost for each cycle of treatment was then calculated. Any toxicities that resulted in hospitalisation of the patient were determined, and the costs incurred were calculated depending on the type of ward to which the patient was admitted. The costs for oxaliplatin in combination with 5-FU/FA compared with 5-FU/FA alone gave the incremental cost to achieve the improvement in progression-free survival. Sensitivity analyses were performed on costs and progression-free survival to give a range of possible values when costs and outcome were varied. The results of the analysis indicate that the costs to achieve an additional progression-free month are around £2,133. In the sensitivity analysis, the majority of scenarios gave similar cost-effectiveness ratios. This gives an average incremental cost of £25,600 to achieve an additional progression-free year. The cost-effectiveness ratio is within acceptable limits and supports the use of oxaliplatin combination therapy in the management of advanced colorectal cancer.     

Comparison of complication and conversion rates between robotic-assisted and laparoscopic rectal resection for rectal cancer: which patients and providers could benefit most from robotic-assisted surgery?

Aims: To compare (1) complication and (2) conversion rates to open surgery (OS) from laparoscopic surgery (LS) and robotic-assisted surgery (RA) for rectal cancer patients who underwent rectal resection. (3) To identify patient, physician, and hospital predictors of conversion.

Materials and methods: A US-based database study was conducted utilizing the 2012–2014 Premier Healthcare Data, including rectal cancer patients ≥18 with rectal resection. ICD-9-CM diagnosis and procedural codes were utilized to identify surgical approaches, conversions to OS, and surgical complications. Propensity score matching on patient, surgeon, and hospital level characteristics was used to create comparable groups of RALS patients (n?=?533 per group). Predictors of conversion from LS and RA to OS were identified with stepwise logistic regression in the unmatched sample.

Results: Post-match results suggested comparable perioperative complication rates (RA 29% vs LS 29%; p?=?.7784); whereas conversion rates to OS were 12% for RA vs 29% for LS (p?<?.0001). Colorectal surgeons (RA 9% vs LS 23%), general surgeons (RA 13% vs LS 35%), and smaller bed-size hospitals (RA 14% vs LS 33%) have reduced conversion rates for RA vs LS (p?<?.0001). Statistically significant predictors of conversion included LS, non-colorectal surgeon, and smaller bed-size hospitals.

Limitations: Retrospective observational study limitations apply. Analysis of the hospital administrative database was subject to the data captured in the database and the accuracy of coding. Propensity score matching limitations apply. RA and LS groups were balanced with respect to measured patient, surgeon, and hospital characteristics.

Conclusions: Compared to LS, RA offers a higher probability of completing a successful minimally invasive surgery for rectal cancer patients undergoing rectal resection without exacerbating complications. Male, obese, or moderately-to-severely ill patients had higher conversion rates. While colorectal surgeons had lower conversion rates from RA than LS, the reduction was magnified for general surgeons and smaller bed-size hospitals.     

‘I Was Trapped at Home’: Men's Experiences with Leisure While Giving Care to Partners During a Breast Cancer Experience

Men whose partners are diagnosed with breast cancer experience many changes to daily living, including taking on additional family and household roles and responsibilities, caring for their partner, and often relinquishing leisure activities. Although leisure participation has been found to help individuals cope and to mitigate the negative effect of traumatic life events, men's experience with leisure during their partners’ breast cancer experience has received little attention. The purpose of this study was to explore men's experiences with leisure and the meaning of those experiences during and following their partners’ breast cancer diagnosis and treatment. Semi-structured, face-to-face interviews were conducted with 10 men. The findings illuminate that men's leisure became more home-based, was used to release and regulate emotions, and provided a means to maintain identity. The illness experience also increased men's appreciation of leisure with their partners.     

miR-652对非小细胞肺癌H460细胞凋亡和迁移的影响

目的 观察miR-652对非小细胞肺癌H460细胞凋亡和迁移的影响.方法 应用细胞计数实验检测miR-652的浓度对肺癌H460细胞的影响;应用细胞划痕实验检测miR-652对肺癌H460细胞迁移的影响;应用蛋白质免疫印迹技术检测肺癌H460细胞凋亡蛋白表达情况.结果 在H460细胞中,miR-652表达显著减少;转染...     

Number needed to treat and associated incremental costs of treatment with enzalutamide versus abiraterone acetate plus prednisone in chemotherapy-naïve patients with metastatic castration-resistant prostate cancer

Objective: Enzalutamide (ENZA) and abiraterone acetate plus prednisone (AA) are approved second-generation hormone therapies for chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC). This study compared ENZA with AA in chemotherapy-naïve mCRPC by calculating the number needed to treat (NNT) and associated incremental costs to achieve one additional chemotherapy-naïve patient with mCRPC free of radiographic progression, chemotherapy, or death over a 1-year time horizon.

Methods: Clinical outcomes were obtained from the PREVAIL and COU-AA-302 trials. Three outcomes were evaluated: radiographic progression-free survival, time to cytotoxic chemotherapy initiation, and overall survival at 1 year. NNT was calculated as the reciprocal of the outcome event rate difference for ENZA compared with AA. The incremental costs to achieve one additional outcome at 1 year were calculated as the difference in cost per treated patient multiplied by the NNT. Per-treated-patient costs were considered from a US payer perspective and included medications, monitoring, adverse events, post-progression treatments, and end-of-life care.

Results: Within a 1-year time horizon, the total cost per treated patient for ENZA was $2,666 less than AA. Compared with AA, treating 14 patients with ENZA resulted in one additional patient free of progression or death over 1 year; treating 26 patients with ENZA resulted in one additional patient with chemotherapy delayed over 1 year; and treating 91 patients with ENZA resulted in one additional patient free of death over 1 year. Therefore, ENZA is cost-effective compared with AA for all three outcomes evaluated, and the modeled results suggest ENZA is associated with potentially improved clinical outcomes in delaying chemotherapy initiation and disease progression for chemotherapy-naïve patients. The results are robust in sensitivity analyses, where the effect of changes in key model inputs and assumptions were tested.

Conclusion: The results modeled in the present study suggest ENZA is cost-effective compared with AA for treating chemotherapy-naïve patients with mCRPC.     

The genetics of breast and ovarian cancer V: application to income protection insurance

In Part IV we presented a comprehensive model of a life history of a woman at risk of breast cancer (BC), in which relevant events such as diagnosis, treatment, recovery and recurrence were represented explicitly, and corresponding transition intensities were estimated. In this part, we study some applications to income protection insurance (IPI) business. We calculate premiums based either on genetic test results or more practically on a family history of BC. We then extend the model into an IPI market model by incorporating rates of insurance-buying behaviour, in order to estimate the possible costs of adverse selection, in terms of increased premiums, under various moratoria on the use of genetic information.