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The productivity cost of mortality due to lung cancer, breast cancer and melanoma in Europe across 2010, 2015 and 2019. 2010 年、2015 年和 2019 年欧洲因肺癌、乳腺癌和黑色素瘤导致死亡的生产成本。
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-08-13 DOI: 10.1016/j.jcpo.2024.100499
Agnes Brandtmüller, Anne Meiwald, Edward Oliver, Robert Hughes, Pedro Miguel Gonzalez Capote, Georgie Weston, Goran Bencina

Background: Cancer caused an estimated 2.2 million deaths across Europe in 2020. This analysis estimated the cost of lost productivity due to premature deaths associated with lung, breast and melanoma cancer and investigated the temporal trends across European regions across 2010, 2015 and 2019.

Method: The human capital approach was used to estimate the indirect costs from lung, melanoma, and breast cancers (ICD-10 code: C33-34, C43, and C50, respectively) in Northern, Eastern, Southern, and Western Europe. Age-specific mortality, and country-specific wages and employment rates were used to calculate years of productive life lost (YPLL), YPLL/death and present value of future lost productivity (PVFLP). Data were sourced from the World Health Organization, Eurostat, and the World Bank.

Results: The number of cancer deaths remained relatively stable from 2010 to 2019. YPLL/death decreased across all European regions and for all cancers between 2010 and 2019 (reported ranges across European regions; lung cancer: 25-42 %; breast cancer: 18-21 %; melanoma: 31-37 %). In Europe, the decrease in PVFLP in 2019 compared to 2010 was €2995M for lung cancer, €295M for melanoma, and €466M for breast cancer, with an overall reduction of productivity cost of €3756M in these cancer types.

Conclusion: The results from this study illustrate a decreased trend in productivity costs from 2010 to 2019 which could be driven by deaths occurring at an older age, suggesting that advances in cancer prevention and the treatment landscape have extended the life of cancer patients, yielding less productivity losses.

Policy summary: The indirect economic costs modelled show the impact of past effective health policies and new treatments. Continued efforts to improve public health policies in supporting public awareness of risk factors and value of early diagnosis could lead to further reduction in these losses. Prevention, early diagnosis, and activation of early treatment pathways could serve to reduce loss of life and improve productivity.

背景:据估计,2020 年欧洲将有 220 万人死于癌症。本分析估计了与肺癌、乳腺癌和黑色素瘤相关的过早死亡导致的生产力损失成本,并调查了 2010 年、2015 年和 2019 年欧洲各地区的时间趋势:方法:采用人力资本法估算北欧、东欧、南欧和西欧因肺癌、黑色素瘤和乳腺癌(ICD-10 代码分别为 C33-34、C43 和 C50)造成的间接成本。特定年龄的死亡率、特定国家的工资和就业率被用来计算生产性寿命损失年数(YPLL)、YPLL/死亡和未来生产率损失现值(PVFLP)。数据来源于世界卫生组织、欧盟统计局和世界银行:2010-2019 年间,癌症死亡人数保持相对稳定。2010-2019 年间,所有欧洲地区和所有癌症的 YPLL/death 均有所下降(各欧洲地区的报告范围;肺癌:25-42%;乳腺癌:18-21%;黑色素瘤:31-37%)。在欧洲,与 2010 年相比,2019 年肺癌的 PVFLP 降低了 29.95 亿欧元,黑色素瘤降低了 2.95 亿欧元,乳腺癌降低了 4.66 亿欧元,这些癌症类型的总体生产成本降低了 37.56 亿欧元:这项研究的结果表明,2010 年至 2019 年期间,生产力成本呈下降趋势,这可能是由于死亡年龄较大,表明癌症预防和治疗领域的进步延长了癌症患者的寿命,减少了生产力损失。继续努力改进公共卫生政策,提高公众对风险因素和早期诊断价值的认识,可以进一步减少这些损失。预防、早期诊断和启动早期治疗途径可减少生命损失并提高生产力。
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引用次数: 0
Scenario analysis and multi-criteria decision analysis to explore alternative reimbursement pathways for whole genome sequencing for blood cancer patients 通过情景分析和多标准决策分析,探索血癌患者全基因组测序的替代报销途径。
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-08-12 DOI: 10.1016/j.jcpo.2024.100501
Martin Vu , Koen Degeling , David Westerman , Maarten J. IJzerman

Background

Whole genome sequencing (WGS) has transformative potential for blood cancer management, but reimbursement is hindered by uncertain benefits relative to added costs. This study employed scenario planning and multi-criteria decision analysis (MCDA) to evaluate stakeholders’ preferences for alternative reimbursement pathways, informing future health technology assessment (HTA) submission of WGS in blood cancer.

Methods

Key factors influencing WGS reimbursement in blood cancers were identified through a literature search. Hypothetical scenarios describing various evidential characteristics of WGS for HTA were developed using the morphological approach. An online survey, incorporating MCDA weights, was designed to gather stakeholder preferences (consumers/patients, clinicians/health professionals, industry representatives, health economists, and HTA committee members) for these scenarios. The survey assessed participants' approval of WGS reimbursement for each scenario, and scenario preferences were determined using the geometric mean method, applying an algorithm to improve reliability and precision by addressing inconsistent responses.

Results

Nineteen participants provided complete survey responses, primarily clinicians or health professionals (n = 6; 32 %), consumers/patients and industry representatives (both at n = 5; 26 %). “Clinical impact of WGS results on patient care" was the most critical criterion (criteria weight of 0.25), followed by "diagnostic accuracy of WGS" (0.21), "cost-effectiveness of WGS" (0.19), "availability of reimbursed treatment after WGS" (0.16), and "eligibility criteria for reimbursed treatment based on actionable WGS results" and "cost comparison of WGS" (both at 0.09). Participants preferred a scenario with substantial clinical evidence, high access to reimbursed targeted treatment, cost-effectiveness below $50,000 per quality-adjusted life year (QALY) gained, and affordability relative to standard molecular tests. Reimbursement was initially opposed until criteria such as equal cost to standard tests and better treatment accessibility were met.

Conclusion

Payers commonly emphasize acceptable cost-effectiveness, but strong clinical evidence for many variants and comparable costs to standard tests are likely to drive positive reimbursement decisions for WGS.

背景:全基因组测序(WGS)在血癌管理方面具有变革性的潜力,但相对于增加的成本,其效益并不确定,这阻碍了报销。本研究采用情景规划和多标准决策分析(MCDA)评估利益相关者对替代报销途径的偏好,为今后提交血癌 WGS 健康技术评估(HTA)提供信息:方法:通过文献检索确定了影响血癌 WGS 报销的关键因素。采用形态学方法为 HTA 制定了描述 WGS 各种证据特征的假设情景。结合 MCDA 权重设计了一项在线调查,以收集利益相关者(消费者/患者、临床医生/卫生专业人员、行业代表、卫生经济学家和 HTA 委员会成员)对这些情景的偏好。调查评估了参与者对每种情景下 WGS 补偿的认可度,并使用几何平均法确定了情景偏好,同时采用了一种算法,通过处理不一致的回答来提高可靠性和精确度:19 位参与者提供了完整的调查回复,主要是临床医生或卫生专业人员(n = 6;32%)、消费者/患者和行业代表(均为 n = 5;26%)。"WGS 结果对患者护理的临床影响 "是最关键的标准(标准权重为 0.25),其次是 "WGS 的诊断准确性"(0.21)、"WGS 的成本效益"(0.19)、"WGS 后可获得有偿治疗"(0.16)、"基于可操作 WGS 结果的有偿治疗资格标准 "和 "WGS 的成本比较"(均为 0.09)。参与者倾向于有大量临床证据、可获得大量有偿靶向治疗、每质量调整生命年(QALY)获得的成本效益低于 50,000 美元以及相对于标准分子检测更经济实惠的方案。在满足与标准检测相同的成本和更好的治疗可及性等标准之前,报销最初遭到反对:付款人通常强调可接受的成本效益,但许多变异的有力临床证据和与标准检测相当的成本可能会促使对 WGS 做出积极的报销决定。
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引用次数: 0
Globalization of clinical research in oncology: Status, challenges, and future directions 肿瘤学临床研究的全球化:现状、挑战和未来方向。
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-08-10 DOI: 10.1016/j.jcpo.2024.100500
Ana Tečić Vuger , Robert Separovic , Sara M. Tolaney , Dario Trapani

Purpose

Cancer is the second-leading cause of death worldwide, and its burden is increasing around the world, particularly in low- and middle-income countries (LMICs). Yet, cancer research has historically been conducted primarily in high-income countries (HICs).

Methods

In this review, we describe the results of our literature search into the current state of international cancer trials, including the benefits, challenges, limitations, and ethical concerns regarding the international conduct of HIC-led trials. We also propose some possible means of addressing these challenges and overcoming these barriers to extend the benefits of cancer research to people around the world.

Results

Over the last several decades, there has been a shift toward inclusion of investigators and participants from LMICs in pivotal cancer clinical trials.

Conclusions

While inclusion of LMIC countries has benefits, including increased diversity of participant populations, investment in research infrastructure in LMICs, and potential expansion of cancer treatment options around the world, the continued leadership of most trials by HICs presents ethical concerns, including potential exploitation of researchers and participants from LMICs, lack of focus on cancer types prevalent in all participating regions, and disparities in access to approved therapies once the trial is complete.

目的:癌症是全球第二大死因,在世界各地,尤其是在中低收入国家(LMICs),癌症负担日益加重。然而,癌症研究历来主要在高收入国家(HICs)进行:在这篇综述中,我们描述了我们对国际癌症试验现状的文献检索结果,包括由高收入国家主导的国际试验所带来的益处、挑战、局限性和伦理问题。我们还提出了一些应对这些挑战和克服这些障碍的可行方法,以扩大癌症研究对全世界人民的惠益:在过去的几十年里,关键性癌症临床试验的研究者和参与者已经开始向低收入和中等收入国家转变:虽然将低收入与中等收入国家纳入进来有很多好处,包括增加参与人群的多样性、对低收入与中等收入国家的研究基础设施进行投资,以及有可能在全球范围内扩大癌症治疗选择,但大多数试验仍由高收入与中等收入国家主导会带来伦理问题,包括可能剥削低收入与中等收入国家的研究人员和参与者、缺乏对所有参与地区流行的癌症类型的关注,以及试验完成后获得批准疗法的机会不均等。
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引用次数: 0
Smoking and alcohol habits in head and neck cancers: How many patients stop after diagnosis? 头颈部癌症患者的吸烟和饮酒习惯:有多少患者在确诊后戒烟?
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-07-25 DOI: 10.1016/j.jcpo.2024.100498
Barbara Verro , Giuseppe Saraniti , Simona Fiumara , Gaetano Ottoveggio , Carmelo Saraniti

Background

Smoking and alcohol are the main risk factors for head and neck cancer. Despite the significant psychological impact, many patients continue to smoke and drink alcohol after diagnosis of cancer. This study aims to analyze the patients’ behavior post diagnosis and treatment of head and neck cancer.

Methods

An observational retrospective study was conducted on patients suffering from head and neck cancer. Their smoking and alcohol habits before and after diagnosis of cancer were studied.

Results

A total of 85 patients were recruited: 80 % males, mean age 61.77±9.30 years. Among smokers, 35.80 % continued smoking post-diagnosis. A statistically significant correlation was found between smoking habit after diagnosis of cancer and type of treatment and tracheostomy. Among drinkers, 65.52 % continued to consume alcohol after diagnosis of cancer. A statistically significant correlation was found between alcohol consumption post-diagnosis and sex.

Conclusions

Patients undergoing more invasive treatments are more likely to quit smoking and/or drinking alcohol, suggesting the strong psychological impact of cancer and its therapy. Many patients continue smoking and consuming alcohol due to unawareness, depression, or addiction. However, most patients reduced cigarette smoking and alcohol consumption. Comprehensive care, including psychological support, is essential for these patients.

背景:吸烟和饮酒是头颈部癌症的主要危险因素。尽管吸烟和饮酒对患者的心理有很大影响,但许多患者在确诊癌症后仍继续吸烟和饮酒。本研究旨在分析头颈部癌症患者在确诊和治疗后的行为:方法:对头颈部癌症患者进行观察性回顾研究。方法:对头颈部癌症患者进行观察性回顾研究,研究他们在确诊癌症前后的吸烟和饮酒习惯:结果:共招募了 85 名患者:男性占 80%,平均年龄(61.77±9.30)岁。吸烟者中,35.80%在确诊后继续吸烟。癌症确诊后的吸烟习惯与治疗类型和气管切开术之间存在统计学意义上的相关性。在饮酒者中,65.52% 的人在确诊癌症后继续饮酒。诊断后饮酒与性别之间存在统计学意义上的相关性:结论:接受侵入性较强治疗的患者更有可能戒烟和/或戒酒,这表明癌症及其治疗对患者的心理影响很大。许多患者由于不了解、抑郁或成瘾而继续吸烟和饮酒。不过,大多数患者都减少了吸烟和饮酒。对这些患者来说,包括心理支持在内的全面护理至关重要。
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引用次数: 0
A cross-sector approach to explore socio-ecological associations with treatment engagement behaviours in Northern Ghana 在加纳北部采用跨部门方法探索与参与治疗行为相关的社会生态因素。
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-07-25 DOI: 10.1016/j.jcpo.2024.100497
Chloe Tuck , Laura Gray , Hamza Suraj , Abdul-Rashid Timtoni Iddrisu , Tampuri Rahman Abane , Richmond Aryeetey , Braimah Abubakari Baba , Robert Akparibo , Richard Cooper

Background

Cancer presents a growing global burden, not least in African countries such as Ghana where high cancer treatment dropouts has been identified due to numerous social, cultural and financial reasons. There is little understanding regarding patterns of treatment access behaviour, especially in Northern Ghana, which this study was designed to explore.

Methods

Through cross-sector collaboration, we extracted and clinically validated cancer patient records available in the Tamale Teaching Hospital. These were analysed descriptively and through multi-variate logistic regression. A treatment mapping process was also applied to highlight challenges in data collection. Multiple imputation with chained equations was conducted for high levels of missing data. Sensitivity analysis was applied to assess the impact of missing data.

Results

Treatment drop-out was high even when uncertainty due to missing data was accounted for, and only 27 % of patients completely engaged with treatment. High drop-out was found for all cancers including those covered by the Ghana National Health Insurance scheme. Multi-variate logistic regression revealed that social, health condition and systemic factors influence treatment engagement until completion. High missing data was observed for liver, ovarian, colorectal, gastric, bladder, oesophageal and head and neck and skin cancers, and soft tissue sarcomas, which limited model fitting.

Conclusion

Treatment drop-out is a critical issue in Northern Ghana. There was high missing data due to the dynamic, complex and decentralised treatment pathway. Future studies are needed to understand the complex challenges in data recording.

Policy summary

Treatment drop out is a pertinent issue that policy makers should look to address. Further discussion with stakeholders involved in cancer treatment and data collection is required to better understand challenges to routine data collection in the local setting. This will allow policy to be designed to cater for the impact of multiple intersecting health and social factors on treatment completion.

背景:癌症给全球带来了日益沉重的负担,尤其是在加纳等非洲国家,由于社会、文化和经济等多方面的原因,癌症治疗的辍学率很高。人们对接受治疗的行为模式知之甚少,尤其是在加纳北部,本研究就是为了探讨这一问题:通过跨部门合作,我们提取并临床验证了塔马利教学医院的癌症患者病历。我们对这些记录进行了描述性分析和多变量逻辑回归分析。我们还采用了治疗映射流程,以突出数据收集中的挑战。对于大量缺失数据,采用了链式方程进行多重估算。对缺失数据的影响进行了敏感性分析:结果:即使考虑到数据缺失造成的不确定性,治疗退出率也很高,只有 27% 的患者完全接受了治疗。所有癌症(包括加纳国家医疗保险计划覆盖的癌症)的辍治率都很高。多变量逻辑回归显示,社会、健康状况和系统性因素会影响治疗的参与度,直至完成治疗。肝癌、卵巢癌、结直肠癌、胃癌、膀胱癌、食道癌、头颈部和皮肤癌以及软组织肉瘤的数据缺失率较高,这限制了模型的拟合:结论:辍治是加纳北部的一个关键问题。由于治疗路径的动态性、复杂性和分散性,数据缺失率很高。未来的研究需要了解数据记录方面的复杂挑战。政策总结:辍治是一个相关问题,政策制定者应努力解决。需要与参与癌症治疗和数据收集的利益相关者进行进一步讨论,以更好地了解在当地环境下常规数据收集所面临的挑战。这将有助于制定政策,以应对多种相互交织的健康和社会因素对完成治疗的影响。
{"title":"A cross-sector approach to explore socio-ecological associations with treatment engagement behaviours in Northern Ghana","authors":"Chloe Tuck ,&nbsp;Laura Gray ,&nbsp;Hamza Suraj ,&nbsp;Abdul-Rashid Timtoni Iddrisu ,&nbsp;Tampuri Rahman Abane ,&nbsp;Richmond Aryeetey ,&nbsp;Braimah Abubakari Baba ,&nbsp;Robert Akparibo ,&nbsp;Richard Cooper","doi":"10.1016/j.jcpo.2024.100497","DOIUrl":"10.1016/j.jcpo.2024.100497","url":null,"abstract":"<div><h3>Background</h3><p>Cancer presents a growing global burden, not least in African countries such as Ghana where high cancer treatment dropouts has been identified due to numerous social, cultural and financial reasons. There is little understanding regarding patterns of treatment access behaviour, especially in Northern Ghana, which this study was designed to explore.</p></div><div><h3>Methods</h3><p>Through cross-sector collaboration, we extracted and clinically validated cancer patient records available in the Tamale Teaching Hospital. These were analysed descriptively and through multi-variate logistic regression. A treatment mapping process was also applied to highlight challenges in data collection. Multiple imputation with chained equations was conducted for high levels of missing data. Sensitivity analysis was applied to assess the impact of missing data.</p></div><div><h3>Results</h3><p>Treatment drop-out was high even when uncertainty due to missing data was accounted for, and only 27 % of patients completely engaged with treatment. High drop-out was found for all cancers including those covered by the Ghana National Health Insurance scheme. Multi-variate logistic regression revealed that social, health condition and systemic factors influence treatment engagement until completion. High missing data was observed for liver, ovarian, colorectal, gastric, bladder, oesophageal and head and neck and skin cancers, and soft tissue sarcomas, which limited model fitting.</p></div><div><h3>Conclusion</h3><p>Treatment drop-out is a critical issue in Northern Ghana. There was high missing data due to the dynamic, complex and decentralised treatment pathway. Future studies are needed to understand the complex challenges in data recording.</p></div><div><h3>Policy summary</h3><p>Treatment drop out is a pertinent issue that policy makers should look to address. Further discussion with stakeholders involved in cancer treatment and data collection is required to better understand challenges to routine data collection in the local setting. This will allow policy to be designed to cater for the impact of multiple intersecting health and social factors on treatment completion.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"41 ","pages":"Article 100497"},"PeriodicalIF":2.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538324000316/pdfft?md5=9aa42e3388642df1e933f8bb0d6d5c5a&pid=1-s2.0-S2213538324000316-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Inclusivity of patients in early phase breast cancer clinical trials 早期乳腺癌临床试验的患者包容性
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-07-20 DOI: 10.1016/j.jcpo.2024.100494
A. Sinha , L. Barwell , H. Jeffery , Z. Peterson , B. Shifa , M. Attia , K. Badawy , A. Purushotham

Introduction

Studies have shown that certain groups of patients are underrepresented in clinical trials including non-Caucasian ethnicity, poor fluency in English, low socioeconomic status, older age, neurodivergence, and large Body Mass Index (BMI). There is a need to ensure adequate representation of these groups so that the results of any trial accurately reflect the population.

The aim of this study was to review the pathway of patients recruited into two early phase breast cancer clinical and determine the inclusivity of patients from the aforementioned sub-groups.

Methods

The Breast Cancer Research Database was reviewed, and the characteristics of all patients who were screened for eligibility in two early phase clinical trials was examined. The English Indices of Deprivation was used to populate the Index of Multiple Deprivation (IMD) for each patient using their postcode.

Results

In total, 392 patients were eligible to participate, between September 2020 to May 2023. Of these, 144 (36.7 %) were recruited to these two trials. In all, 100 % of patients eligible for these trials were approached and screened for participation. Eligible patients had a mean age of 53.5 years. Recruited patients were younger on average than those not recruited (49.1 years vs 56.0 years, p<0.0001). Only one recruited patient required an interpreter, compared with 24 (9.7 %%) of those who were not recruited (p<0.001).

There was no difference in the IMD (p=0.38), BMI (p=0.34) and neurodiversity (p=0.10) between patients recruited into clinical trials and those who were not.

Conclusion

Older age and poor fluency in the English language remain barriers to participation in early-phase clinical trials despite implementing a clear pathway to trial recruitment. There is a pressing need to address these barriers by raising awareness, improve appropriate training and providing comprehensive trial information to patients in the language of their choice.

导言:研究表明,某些患者群体在临床试验中的代表性不足,包括非白种人、英语不流利、社会经济地位低下、年龄偏大、神经分裂和体重指数(BMI)偏高。本研究的目的是回顾两项早期乳腺癌临床试验招募患者的途径,并确定上述亚群患者的包容性。方法回顾乳腺癌研究数据库,并检查两项早期临床试验中所有通过资格筛选的患者的特征。结果在 2020 年 9 月至 2023 年 5 月期间,共有 392 名患者符合参与资格。其中,144 人(36.7%)被招募参加这两项试验。总之,符合试验条件的患者100%都经过了接触和筛选。符合条件的患者平均年龄为 53.5 岁。被招募的患者平均年龄比未被招募的患者年轻(49.1 岁对 56.0 岁,p<0.0001)。被招募参加临床试验的患者与未被招募参加临床试验的患者在IMD(p=0.38)、BMI(p=0.34)和神经多样性(p=0.10)方面没有差异。结论尽管实施了明确的试验招募途径,但高龄和英语不流利仍然是参加早期临床试验的障碍。迫切需要通过提高认识、加强适当的培训以及用患者选择的语言向其提供全面的试验信息来解决这些障碍。
{"title":"Inclusivity of patients in early phase breast cancer clinical trials","authors":"A. Sinha ,&nbsp;L. Barwell ,&nbsp;H. Jeffery ,&nbsp;Z. Peterson ,&nbsp;B. Shifa ,&nbsp;M. Attia ,&nbsp;K. Badawy ,&nbsp;A. Purushotham","doi":"10.1016/j.jcpo.2024.100494","DOIUrl":"10.1016/j.jcpo.2024.100494","url":null,"abstract":"<div><h3>Introduction</h3><p>Studies have shown that certain groups of patients are underrepresented in clinical trials including non-Caucasian ethnicity, poor fluency in English, low socioeconomic status, older age, neurodivergence, and large Body Mass Index (BMI). There is a need to ensure adequate representation of these groups so that the results of any trial accurately reflect the population.</p><p>The aim of this study was to review the pathway of patients recruited into two early phase breast cancer clinical and determine the inclusivity of patients from the aforementioned sub-groups.</p></div><div><h3>Methods</h3><p>The Breast Cancer Research Database was reviewed, and the characteristics of all patients who were screened for eligibility in two early phase clinical trials was examined. The English Indices of Deprivation was used to populate the Index of Multiple Deprivation (IMD) for each patient using their postcode.</p></div><div><h3>Results</h3><p>In total, 392 patients were eligible to participate, between September 2020 to May 2023. Of these, 144 (36.7 %) were recruited to these two trials. In all, 100 % of patients eligible for these trials were approached and screened for participation. Eligible patients had a mean age of 53.5 years. Recruited patients were younger on average than those not recruited (49.1 years vs 56.0 years, p&lt;0.0001). Only one recruited patient required an interpreter, compared with 24 (9.7 %%) of those who were not recruited (p&lt;0.001).</p><p>There was no difference in the IMD (p=0.38), BMI (p=0.34) and neurodiversity (p=0.10) between patients recruited into clinical trials and those who were not.</p></div><div><h3>Conclusion</h3><p>Older age and poor fluency in the English language remain barriers to participation in early-phase clinical trials despite implementing a clear pathway to trial recruitment. There is a pressing need to address these barriers by raising awareness, improve appropriate training and providing comprehensive trial information to patients in the language of their choice.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"41 ","pages":"Article 100494"},"PeriodicalIF":2.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141736435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Real-world cost-effectiveness of panel-based genomic testing to inform therapeutic decisions for metastatic colorectal cancer 为转移性结直肠癌治疗决策提供信息的基于面板的基因组测试的实际成本效益
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-07-18 DOI: 10.1016/j.jcpo.2024.100496
Reka E. Pataky , Deirdre Weymann , Ian Bosdet , Stephen Yip , Stirling Bryan , Mohsen Sadatsafavi , Stuart Peacock , Dean A. Regier

Background

Mutations in KRAS and NRAS are associated with a lack of response to cetuximab and panitumumab, two biologics used for third-line therapy of metastatic colorectal cancer (mCRC). In British Columbia, Canada, eligibility for cetuximab or panitumumab was first based on single-gene KRAS testing. OncoPanel, a multi-gene next-generation sequencing panel with both KRAS and NRAS, was introduced in 2016. Our objective was to estimate the real-world cost-effectiveness of OncoPanel versus to single-gene KRAS testing to inform eligibility for cetuximab or panitumumab in mCRC.

Methods

Using population-based administrative health data, we identified a cohort of mCRC patients who had received a KRAS or OncoPanel test, and completed prior chemotherapy in 2010–2019. We matched KRAS- and OncoPanel-tested patients (1:1) using genetic matching to balance baseline covariates. Mean and incremental 3-year costs, survival, and quality-adjusted survival were estimated using inverse-probability-of-censoring weighting and bootstrapping. We conducted scenario-based sensitivity analysis for key costs and assumptions.

Findings

All OncoPanel-tested cases (n=371) were matched to a KRAS-tested comparator. In the KRAS and OncoPanel groups, respectively, 55·8 % and 41·2 % of patients were potentially eligible for cetuximab or panitumumab based on mutation status. Incremental cost and effectiveness of OncoPanel were $72 (95 % CI: −6387, 6107), −0·004 life-years (95 % CI: −0·119, 0·113), and −0·011 quality-adjusted life-years (95 % CI: −0·094, 0·075). Reductions in systemic therapy costs were offset by increased costs in other resources. Results were moderately sensitive to time horizon and changes in testing or treatment cost.

Interpretation

The use of OncoPanel resulted in more precise targeting of cetuximab and panitumumab, but there was no change in incremental cost or quality-adjusted survival. Understanding the balance of costs achieved in practice can provide insight into the effect of future changes in testing policy, test cost, treatment eligibility, or drug prices in this setting.

背景KRAS和NRAS突变与对西妥昔单抗和帕尼单抗缺乏反应有关,这两种生物制剂被用于转移性结直肠癌(mCRC)的三线治疗。在加拿大不列颠哥伦比亚省,西妥昔单抗或帕尼单抗的治疗资格首先基于单基因 KRAS 检测。2016年推出了同时检测KRAS和NRAS的多基因新一代测序面板OncoPanel。我们的目标是估算OncoPanel与单基因KRAS检测的实际成本效益,以告知mCRC患者西妥昔单抗或帕尼单抗的资格。方法利用基于人群的行政健康数据,我们确定了一组接受过KRAS或OncoPanel检测,并在2010-2019年完成了既往化疗的mCRC患者。我们使用基因匹配法对接受 KRAS 和 OncoPanel 检测的患者进行了配对(1:1),以平衡基线协变量。我们使用反概率加权法和引导法估算了平均和增量 3 年成本、生存率和质量调整后生存率。我们对关键成本和假设进行了基于情景的敏感性分析。研究结果所有经过 OncoPanel 检测的病例(n=371)都与经过 KRAS 检测的比较者相匹配。在 KRAS 组和 OncoPanel 组中,根据突变状态,分别有 55-8% 和 41-2% 的患者可能符合西妥昔单抗或帕尼单抗的治疗条件。OncoPanel的增量成本和有效性分别为72美元(95 % CI:-6387,6107)、-0-004生命年(95 % CI:-0-119,0-113)和-0-011质量调整生命年(95 % CI:-0-094,0-075)。系统治疗成本的减少被其他资源成本的增加所抵消。结果对时间跨度和检测或治疗成本的变化适度敏感。解释:OncoPanel的使用使西妥昔单抗和帕尼单抗的靶向性更精确,但增量成本或质量调整生存期没有变化。了解在实践中实现的成本平衡可以帮助人们了解未来在这种情况下改变检测政策、检测成本、治疗资格或药物价格的效果。
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引用次数: 0
Bridging cancer prevention efforts: Georgia's alignment with European code against cancer 癌症预防工作的桥梁:格鲁吉亚与《欧洲抗癌法典》接轨。
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-07-14 DOI: 10.1016/j.jcpo.2024.100495
Miranda Nonikashvili

This report provides a concise overview of how Georgia has integrated the principles of the European Code Against Cancer (ECAC) into its national cancer strategies. Through a structured exploration, we highlight Georgia's commitment to cancer prevention, while addressing the challenges and opportunities encountered.

本报告简要概述了格鲁吉亚如何将《欧洲抗癌法典》(ECAC)的原则纳入其国家癌症战略。通过有条理的探讨,我们强调了格鲁吉亚对癌症预防的承诺,同时也探讨了所遇到的挑战和机遇。
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引用次数: 0
Whole genome sequencing as a ticket to cancer treatment in the Netherlands: Are inequalities in access to molecular diagnostics unfair? 在荷兰,全基因组测序是癌症治疗的入场券:分子诊断机会的不平等是否不公平?
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-06-20 DOI: 10.1016/j.jcpo.2024.100492
Jilles Smids , Charlotte Bomhof , Maarten IJzerman , Eline Bunnik

Whole genome sequencing (WGS) of a tumour may sometimes reveal additional potential targets for medical treatment. Practice variation in the use of WGS is therefore a source of unequal access to targeted therapies and, as a consequence, of disparities in health outcomes. Moreover, this may even be more significant if patients seek access to WGS by paying a relatively limited amount of money out of pocket, and sometimes effectively buy themselves a ticket to (very) expensive publicly funded treatments. Should resulting unequal access to WGS be considered unfair? Drawing from current practice in the Dutch healthcare system, known as egalitarian, we argue that differences in employment of WGS between hospitals are the consequence of the fact that medical innovation and its subsequent uptake inevitably takes time. Consequently, temporal inequalities in access can be deemed acceptable, or at least tolerated, because and insofar as, ultimately, all patients benefit. However, we argue against allowing a practice of out-of-pocket payments for WGS in publicly funded healthcare systems, for four reasons: because allowing private spending favours patients with higher socio-economic status significantly more than practice variation between hospitals does, may lead to displacement of publicly funded health care, does not help to ultimately benefit all, and may undermine the solidaristic ethos essential for egalitarian healthcare systems.

对肿瘤进行全基因组测序(WGS)有时会发现更多潜在的治疗靶点。因此,使用 WGS 的实践差异是造成靶向治疗机会不平等的一个原因,也是造成健康结果差异的一个原因。此外,如果患者只需自掏腰包支付相对有限的费用就能使用 WGS,有时还能为自己买到一张(非常)昂贵的公共资助治疗的门票,那么这种情况可能会更加严重。由此造成的 WGS 使用机会不平等是否应被视为不公平?根据荷兰医疗保健系统的现行做法(被称为平等主义),我们认为,不同医院在使用 WGS 方面的差异是医疗创新及其后续普及不可避免地需要时间的结果。因此,时间上的不平等是可以接受的,至少是可以容忍的,因为最终所有患者都会受益。然而,我们反对在公费医疗系统中允许自费进行 WGS,理由有四:允许自费对社会经济地位较高的患者有利的程度远高于医院之间的做法差异,可能导致公费医疗被取代,无助于最终使所有人受益,并可能破坏平等主义医疗系统所必需的团结精神。
{"title":"Whole genome sequencing as a ticket to cancer treatment in the Netherlands: Are inequalities in access to molecular diagnostics unfair?","authors":"Jilles Smids ,&nbsp;Charlotte Bomhof ,&nbsp;Maarten IJzerman ,&nbsp;Eline Bunnik","doi":"10.1016/j.jcpo.2024.100492","DOIUrl":"10.1016/j.jcpo.2024.100492","url":null,"abstract":"<div><p>Whole genome sequencing (WGS) of a tumour may sometimes reveal additional potential targets for medical treatment. Practice variation in the use of WGS is therefore a source of unequal access to targeted therapies and, as a consequence, of disparities in health outcomes. Moreover, this may even be more significant if patients seek access to WGS by paying a relatively limited amount of money out of pocket, and sometimes effectively buy themselves a ticket to (very) expensive publicly funded treatments. Should resulting unequal access to WGS be considered unfair? Drawing from current practice in the Dutch healthcare system, known as egalitarian, we argue that differences in employment of WGS between hospitals are the consequence of the fact that medical innovation and its subsequent uptake inevitably takes time. Consequently, temporal inequalities in access can be deemed acceptable, or at least tolerated, because and insofar as, ultimately, all patients benefit. However, we argue <em>against</em> allowing a practice of out-of-pocket payments for WGS in publicly funded healthcare systems, for four reasons: because allowing private spending favours patients with higher socio-economic status significantly more than practice variation between hospitals does, may lead to displacement of publicly funded health care, does not help to ultimately benefit all, and may undermine the solidaristic ethos essential for egalitarian healthcare systems.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"41 ","pages":"Article 100492"},"PeriodicalIF":2.0,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141440940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pharmaceutical company funding of cancer patient advocacy organizations in the Netherlands 荷兰制药公司对癌症患者权益保护组织的资助》(Pharmaceutical Company Funding of Cancer Patient Advocacy Organizations in the Netherlands)。
IF 1.3 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-06-12 DOI: 10.1016/j.jcpo.2024.100493
Anne M.J. Somers , Ashley J. Duits , Michael J. Samson , John-John B. Schnog

Background

Financial conflicts of interest (FCOI) of medical professionals and associated organizations with pharmaceutical companies (pharma) might contribute to the use of low value oncological treatments. Value criteria for oncological drug approvals in the Netherlands have recently become more stringent leading to objections by cancer patient advocacy organizations (cPAOs). Considering the importance of cPAOs input in cancer patient care we analyzed whether pharma funding of cPAOs occurs in the Netherlands.

Methods

The cPAO websites and available annual reports were evaluated for disclosure of pharma funding for the years 2021 and 2022. Also, data from the Dutch Healthcare Transparency Registry (DHTR) were extracted.

Results

Twenty-one of 34 (61.8 %) cPAOs received pharma funding (with 20 registered in the DHTR), and for 13 (29.4 %) cPAOs no reporting of pharma funding could be found. Three of the cPAOs disclosed pharma funding directly on their main website. Online educational material was available from 22 cPAOs on their websites with pharma funding disclosed on the educational material in 5. The total registered amount of pharmaceutical funding was €667,232.00 in 2021 and €536,098.00 in 2022. The median (and interquartile ranges) DHTR registered amount of support per cPAO that received funding in the studied period was €23,799.50 (14,823.75–84,663.30). The most common funding category as defined in the DHTR was project sponsorship.

Conclusions

Financial support by the pharmaceutical industry is common for Dutch cPAOs. Given the importance of cPAOs and their objective input in the societal debate on the availability of cancer drugs, the potential influence of pharma sponsoring should be critically evaluated.

背景:医疗专业人员和相关组织与制药公司(pharma)的经济利益冲突(FCOI)可能会导致低价值肿瘤治疗的使用。最近,荷兰肿瘤药物审批的价值标准变得更加严格,导致癌症患者权益组织(cPAOs)提出反对意见。考虑到癌症患者权益组织在癌症患者治疗中的重要性,我们分析了荷兰是否存在制药公司资助癌症患者权益组织的情况:方法:我们对 cPAO 网站和现有年度报告进行了评估,以了解 2021 年和 2022 年的制药资助披露情况。此外,还提取了荷兰医疗透明度登记处(DHTR)的数据:结果:34 个 cPAO 中有 21 个(61.8%)接受了制药公司的资助(其中 20 个在 DHTR 中登记),13 个(29.4%)cPAO 没有报告制药公司的资助。其中 3 个社区公共行政组织在其主网站上直接披露了制药资助。22 个注册会计师组织在其网站上提供了在线教育材料,其中 5 个组织在教育材料中披露了制药资助。2021 年登记的制药资助总额为 667,232.00 欧元,2022 年为 536,098.00 欧元。在研究期间,每个接受资助的 cPAO 所登记的 DHTR 资助金额中位数(和四分位数之间的范围)为 23,799.50 欧元(IQR 为 14,823.75-84,663.30 欧元)。根据 DHTR 的定义,最常见的资助类别是项目赞助:结论:荷兰 cPAO 普遍得到制药业的资金支持。鉴于 cPAO 的重要性及其在社会关于抗癌药物可用性讨论中的客观投入,应严格评估制药业赞助的潜在影响。
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引用次数: 0
期刊
Journal of Cancer Policy
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