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Cancer Survivorship and Supportive Care Economics Research: Current Challenges and Next Steps. 癌症生存和支持性护理经济学研究:当前的挑战和下一步。
Pub Date : 2022-07-05 DOI: 10.1093/jncimonographs/lgac004
Lauren Hersch Nicholas, Amy J Davidoff, David H Howard, Nancy L Keating, Debra P Ritzwoller, K Robin Yabroff, Cathy J Bradley

Background: Rapid growth in the number of cancer survivors raises numerous questions about health and economic outcomes among survivors along with their families, caregivers, and employers. Health economics theory and methods can contribute to many open questions to improve survivorship.

Methods: In this paper, we review key areas where more research is needed and describe strategies for improving data infrastructure, research funding, and capacity building to strengthen survivorship health economics research.

Conclusions: Health economics has broadened an understanding of key supply- and demand-side factors that promote cancer survivorship. To ensure necessary research in survivorship health economics moving forward, we recommend dedicated funding, inclusion of health economics outcomes in primary data collection, and investments in secondary data sets.

背景:癌症幸存者数量的快速增长,对幸存者及其家人、照顾者和雇主的健康和经济结果提出了许多问题。健康经济学的理论和方法可以帮助解决许多悬而未决的问题,以提高生存率。方法:在本文中,我们回顾了需要更多研究的关键领域,并描述了改善数据基础设施、研究资金和能力建设的策略,以加强生存健康经济学的研究。结论:卫生经济学拓宽了对促进癌症生存的关键供给侧和需求侧因素的理解。为了确保幸存者健康经济学的必要研究向前发展,我们建议提供专门资金,将卫生经济学结果纳入初级数据收集,并对二级数据集进行投资。
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引用次数: 1
How Data Security Concerns Can Hinder Natural Experiment Research: Background and Potential Solutions. 数据安全问题如何阻碍自然实验研究:背景与潜在解决方案。
Pub Date : 2022-07-05 DOI: 10.1093/jncimonographs/lgac007
Michael F Pesko

Health economists conducting cancer-related research often use geocoded data to analyze natural experiments generated by policy changes. These natural experiments can provide causal interpretation under certain conditions. Despite public health benefit of this rigorous natural experiment methodology, data providers are often reluctant to provide geocoded data because of confidentiality concerns. This paper provides an example of the value of natural experiments from e-cigarette research and shows how this research was hindered by security concerns. Although the tension between data access and security will not be resolved overnight, this paper offers 3 recommendations: 1) provide public access to aggregated data at area levels (eg, state) where possible; 2) approve projects with enough time to allow for publication in journals with lengthy peer-review times; and 3) improve communication and transparency between data providers and the research community. The Foundations for Evidence Based Policymaking Act of 2018 also presents a unique opportunity for improving the ability of researchers to use geocoded data for natural experiment research without compromising data security.

进行癌症相关研究的卫生经济学家经常使用地理编码数据来分析政策变化所产生的自然实验。在某些条件下,这些自然实验可以提供因果解释。尽管这种严格的自然实验方法对公共健康有益,但数据提供者往往出于保密考虑而不愿提供地理编码数据。本文举例说明了电子烟研究中自然实验的价值,并展示了这项研究是如何因安全问题而受阻的。虽然数据访问与安全之间的矛盾不会在一夜之间得到解决,但本文提出了 3 项建议:1) 尽可能在地区层面(如州)向公众提供对汇总数据的访问;2) 在足够长的时间内批准项目,以便在同行评审时间较长的期刊上发表论文;3) 改善数据提供者与研究界之间的沟通和透明度。2018 年循证决策基础法案》也为提高研究人员使用地理编码数据进行自然实验研究的能力提供了一个独特的机会,同时又不影响数据的安全性。
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引用次数: 0
Communicating Research to Non-Researcher Audiences: A Panel Discussion From the National Cancer Institute's Future of Cancer Health Economics Research Conference. 向非研究人员观众传达研究:来自国家癌症研究所癌症健康经济学研究会议的未来小组讨论。
Pub Date : 2022-07-05 DOI: 10.1093/jncimonographs/lgab021
Fumiko Chino, Aaron Carroll, Margot Sanger-Katz, Stacie B Dusetzina, S Yousuf Zafar

With rising health-care costs and increasing patient financial strain, health economics research has never been more relevant to the lay public. This manuscript summarizes the discussion from the "Communicating Health Economics Research to Non-Researcher Audiences" expert panel and highlights the foundations of good health/science communication, distilling your work into a newsworthy headline, and communication concerns in specific scenarios. It also provides "dos and don'ts" for promoting your research to the news media and a list of resources on interacting with the press for further study.

随着医疗成本的上升和患者经济压力的增加,卫生经济学研究从未像现在这样与公众息息相关。本文总结了“向非研究人员受众传播卫生经济学研究”专家小组的讨论,并强调了良好的卫生/科学传播的基础,将您的工作提炼成有新闻价值的标题,以及在特定情况下的传播问题。它还提供了向新闻媒体宣传您的研究的“注意事项”,以及与媒体互动以进行进一步研究的资源列表。
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引用次数: 1
Introduction to the Supplement: Is Now the Time for the Future of Cancer Economics Research? 增刊导言:现在是癌症经济学研究未来的时候了吗?
Pub Date : 2022-07-05 DOI: 10.1093/jncimonographs/lgab017
Michael T Halpern

The National Cancer Institute's Division of Cancer Control and Population Sciences hosted a virtual conference, The Future of Cancer Health Economics Research, in December 2020. This conference brought together a multidisciplinary group of researchers and other stakeholders interested in supporting and developing the field of cancer health economics research to help improve both patient outcomes and health-care systems. The introduction to the supplement describes the origins and planning for the conference and the conference sessions and presentations. The papers included in this supplement, arising from the conference sessions, help strengthened our understanding of what is cancer health economics research and how this field can provide even greater contributions in the future.

2020年12月,美国国家癌症研究所癌症控制与人口科学部主办了一场名为“癌症健康经济学研究的未来”的虚拟会议。本次会议汇集了一个多学科研究人员小组和其他利益攸关方,他们有兴趣支持和发展癌症卫生经济学研究领域,以帮助改善患者预后和卫生保健系统。增刊的导言描述了会议的起源和计划以及会议的会议和演讲。本增刊中收录的来自会议的论文有助于加强我们对什么是癌症健康经济学研究以及该领域如何在未来做出更大贡献的理解。
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引用次数: 0
Enhancing Health Equity Through Cancer Health Economics Research. 通过癌症健康经济学研究促进健康公平。
Pub Date : 2022-07-05 DOI: 10.1093/jncimonographs/lgab018
Cathy J Bradley, Kosali Simon, Karen Winkfield, Beverly Moy

Cancer displays some of the largest health-equity concerns of all diseases. This paper draws attention to how health economics research can assess strategies to reduce or even eliminate health disparities and provides pivotal examples of existing research as well as areas for future contributions. The paper also highlights critical data limitations that currently restrain the impact health economics research could have. We then explore new areas of inquiry where economic research is sparse but could have an important impact on health equity, particularly in topics involving Medicare and Medicaid policies that expand reimbursement and generosity of coverage. Health economics studies are notably absent from policies and practices surrounding clinical trials, representing an opportunity for future research. We urge health economics researchers to consider experiments, interventions, and assessments through primary data collection; we further encourage the formulation of multidisciplinary teams to ensure that health economics skills are well melded with other areas of expertise. These teams are needed to maximize novelty and rigor of evidence. As policies are promulgated to address disparities in cancer, involvement of economics in a multidisciplinary context can help ensure that these policies do not have unintended impacts that may deepen inequities.

癌症是所有疾病中最令人关切的健康公平问题之一。本文提请注意卫生经济学研究如何评估减少甚至消除卫生差距的战略,并提供了现有研究的关键例子以及未来贡献的领域。本文还强调了目前限制卫生经济学研究可能产生的影响的关键数据限制。然后,我们探索新的调查领域,其中经济研究很少,但可能对健康公平产生重要影响,特别是涉及扩大报销和慷慨覆盖范围的医疗保险和医疗补助政策的主题。围绕临床试验的政策和实践明显缺乏卫生经济学研究,这为未来的研究提供了机会。我们敦促卫生经济学研究者通过原始数据收集来考虑实验、干预和评估;我们进一步鼓励组建多学科小组,以确保卫生经济学技能与其他领域的专门知识很好地结合起来。这些团队需要最大限度地提高证据的新颖性和严谨性。当制定政策以解决癌症方面的差异时,在多学科背景下参与经济学可以帮助确保这些政策不会产生可能加深不平等的意外影响。
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引用次数: 1
Cancer-Related Care Costs and Employment Disruption: Recommendations to Reduce Patient Economic Burden as Part of Cancer Care Delivery. 癌症相关的护理费用和就业中断:减少患者经济负担作为癌症护理交付的一部分的建议。
Pub Date : 2022-07-05 DOI: 10.1093/jncimonographs/lgac006
Janet S de Moor, Courtney P Williams, Victoria S Blinder

Cancer survivors are frequently unprepared to manage the out-of-pocket (OOP) costs associated with undergoing cancer treatment and the potential for employment disruption. This commentary outlines a set of research recommendations stemming from the National Cancer Institute's Future of Health Economics Research Conference to better understand and reduce patient economic burden as part of cancer care delivery. Currently, there are a lack of detailed metrics and measures of survivors' OOP costs and employment disruption, and data on these costs are rarely available at the point of care to guide patient-centered treatment and survivorship care planning. Future research should improve the collection of data about survivors' OOP costs for medical care, other cancer-related expenses, and experiences of employment disruption. Methods such as microcosting and the prospective collection of patient-reported outcomes in cancer care are needed to understand the true sum of cancer-related costs taken on by survivors and caregivers. Better metrics and measures of survivors' costs must be coupled with interventions to incorporate that information into cancer care delivery and inform meaningful communication about OOP costs and employment disruption that is tailored to different clinical situations. Informing survivors about the anticipated costs of their cancer care supports informed decision making and proactive planning to mitigate financial hardship. Additionally, system-level infrastructure should be developed and tested to facilitate screening to identify survivors at risk for financial hardship, improve communication about OOP costs and employment disruption between survivors and their health-care providers, and support the delivery of appropriate financial navigation services.

癌症幸存者往往没有准备好管理与接受癌症治疗相关的自付费用和潜在的就业中断。本评论概述了一组来自国家癌症研究所卫生经济学未来研究会议的研究建议,以更好地了解和减轻作为癌症治疗提供一部分的患者经济负担。目前,缺乏关于幸存者OOP成本和就业中断的详细指标和措施,并且在护理点上很少有这些成本的数据来指导以患者为中心的治疗和幸存者护理计划。未来的研究应该改进对幸存者在医疗保健、其他癌症相关费用和就业中断经历方面的总体成本数据的收集。为了了解幸存者和护理者所承担的癌症相关费用的真实总和,需要微观成本计算和患者报告的癌症治疗结果的前瞻性收集等方法。幸存者成本的更好的度量和措施必须与干预措施相结合,将这些信息纳入癌症护理服务,并根据不同的临床情况就OOP成本和就业中断进行有意义的沟通。告知幸存者癌症治疗的预期费用,有助于做出明智的决策和积极规划,以减轻经济困难。此外,应开发和测试系统级基础设施,以促进筛选,以确定面临经济困难风险的幸存者,改善幸存者与其保健提供者之间关于OOP费用和就业中断的沟通,并支持提供适当的财务导航服务。
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引用次数: 3
Health Economics Research in Cancer Treatment: Current Challenges and Future Directions. 癌症治疗中的卫生经济学研究:当前挑战与未来方向。
Pub Date : 2022-07-05 DOI: 10.1093/jncimonographs/lgac009
James B Yu, Deborah Schrag, K Robin Yabroff

The National Cancer Institute Division of Cancer Control and Population Science hosted a virtual conference on the Future of Cancer Health Economics Research and included a presentation from a workgroup that considered current challenges and future directions in health economics research centered on cancer treatment. The workgroup identified 3 broad categories of focus: data limitations, opportunities for training for clinicians and health economists interested in collaboration, and the need for prospective economic study of cancer treatment. Within these areas of focus, the workgroup recommended the following: improvement of the availability of key economic measures in data available to researchers, creation of more comprehensive datasets robust to insurance type or coverage, development of cancer care health economics research-focused symposia, instituting clear mechanisms to support integration of economic analyses alongside clinical trials, development of standardized methods to measure the cost of cancer care to health-care systems and patients, and development of standardized evaluations that include measures of social determinants of health.

国家癌症研究所癌症控制和人口科学部主办了一场关于癌症健康经济学研究未来的虚拟会议,其中包括一个工作组的演讲,该工作组审议了以癌症治疗为中心的健康经济学研究的当前挑战和未来方向。工作组确定了3大类重点:数据限制、对合作感兴趣的临床医生和卫生经济学家的培训机会,以及对癌症治疗进行前瞻性经济研究的必要性。在这些重点领域内,工作组建议如下:改善研究人员可获得的数据中关键经济指标的可用性,创建更全面的数据集,以保险类型或覆盖范围为基础,发展以癌症护理卫生经济学研究为重点的专题讨论会,建立明确的机制,支持将经济分析与临床试验结合起来,开发标准化的方法来衡量医疗保健系统和患者的癌症护理成本,制定标准化评估,包括衡量健康的社会决定因素。
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引用次数: 3
Methods and Study Design for Cancer Health Economics Research: Summary of Discussions From a Breakout Session. 癌症卫生经济学研究的方法和研究设计:分组会议讨论摘要。
Pub Date : 2022-07-05 DOI: 10.1093/jncimonographs/lgac013
Henry J Henk, Ya-Chen Tina Shih, Bijan J Borah

The legitimacy of findings from cancer health economics research depends on study design and methods. A breakout session, Methods and Study Design for Cancer Health Economics Research, was convened at the Future of Cancer Health Economics Research Conference to discuss 2 commonly used analytic tools for cancer health economics research: observational studies and decision-analytic modeling. Observational studies include analysis of data collected with the primary purpose of supporting economic evaluation or secondary use of data collected for another purpose. Modeling studies develop a parametrized structure, such as a decision tree, to estimate hypothetical impact. Whereas observational studies focus on what has happened and why, modeling studies address what may happen. We summarize the discussion at this breakout session, focusing on 3 key elements of high-quality cancer health economics research: study design, analytical methods, and addressing uncertainty.

癌症卫生经济学研究结果的合法性取决于研究设计和方法。癌症卫生经济学研究的未来会议召开了一个分组会议,题为 "癌症卫生经济学研究的方法和研究设计",讨论癌症卫生经济学研究的两种常用分析工具:观察研究和决策分析模型。观察性研究包括对收集到的数据进行分析,其主要目的是支持经济评估或对收集到的数据进行二次利用。建模研究建立一个参数化结构,如决策树,以估计假设的影响。观察性研究侧重于已发生的情况及其原因,而建模研究则针对可能发生的情况。我们将总结本次分组会议的讨论,重点关注高质量癌症卫生经济学研究的三个关键要素:研究设计、分析方法和解决不确定性。
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引用次数: 0
Health Economics Research in Primary Prevention of Cancer: Assessment, Current Challenges, and Future Directions. 癌症初级预防中的卫生经济学研究:评估、当前挑战和未来方向》。
Pub Date : 2022-07-05 DOI: 10.1093/jncimonographs/lgac014
Donatus U Ekwueme, Michael T Halpern, Harrell W Chesson, Mahima Ashok, Jeffrey Drope, Young-Rock Hong, Michael Maciosek, Michael F Pesko, Donald S Kenkel

In the past 2 decades, the demand for information on health economics research to guide health care decision making has substantially increased. Studies have provided evidence that eliminating or reducing tobacco use; eating a healthy diet, including fruit and vegetables; being physically active; reducing alcohol consumption; avoiding ultraviolet radiation; and minimizing exposure to environmental and occupational carcinogenic agents should substantially reduce cancer incidence in the population. The benefits of these primary prevention measures in reducing cancer incidence are not instantaneous. Therefore, health economics research has an important role to play in providing credible information to decision makers on the health and economic benefits of primary prevention. This article provides an overview of health economics research related to primary prevention of cancer. We addressed the following questions: 1) What are the gaps and unmet needs for performing health economics research focused on primary prevention of cancer? 2) What are the challenges and opportunities to conducting health economics research to evaluate primary prevention of cancer? and 3) What are the future directions for enhancing health economics research on primary prevention of cancer? Modeling primary prevention of cancer is often difficult given data limitations, long delays before the policy or intervention is effective, possible unintended effects of the policy or intervention, and the necessity of outside expertise to understand key inputs or outputs to the modeling. Despite these challenges, health economics research has an important role to play in providing credible information to decision makers on the health and economic benefits of primary prevention of cancer.

在过去 20 年里,人们对用于指导医疗决策的卫生经济学研究信息的需求大幅增加。研究证明,戒烟或减少吸烟、健康饮食(包括水果和蔬菜)、积极锻炼身体、减少饮酒、避免紫外线辐射以及尽量减少接触环境和职业致癌物质,这些措施应能大幅降低人口的癌症发病率。这些初级预防措施在降低癌症发病率方面的益处并非立竿见影。因此,卫生经济学研究可以发挥重要作用,为决策者提供有关初级预防的卫生和经济效益的可靠信息。本文概述了与癌症一级预防相关的卫生经济学研究。我们探讨了以下问题:1) 在开展以癌症一级预防为重点的卫生经济学研究方面,存在哪些差距和未满足的需求?2)开展卫生经济学研究以评估癌症一级预防面临哪些挑战和机遇? 3)加强癌症一级预防卫生经济学研究的未来方向是什么?鉴于数据的局限性、政策或干预措施生效前的漫长延迟、政策或干预措施可能产生的意外影响,以及需要外部专家来理解建模的关键输入或输出,建立癌症一级预防模型通常十分困难。尽管存在这些挑战,卫生经济学研究仍可发挥重要作用,为决策者提供有关癌症一级预防的卫生和经济效益的可靠信息。
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引用次数: 0
Health Economics Research in Cancer Screening: Research Opportunities, Challenges, and Future Directions. 癌症筛查中的卫生经济学研究:癌症筛查中的卫生经济学研究:研究机遇、挑战和未来方向》。
Pub Date : 2022-07-05 DOI: 10.1093/jncimonographs/lgac008
Ya-Chen Tina Shih, Lindsay M Sabik, Natasha K Stout, Michael T Halpern, Joseph Lipscomb, Scott Ramsey, Debra P Ritzwoller

Cancer screening has long been considered a worthy public health investment. Health economics offers the theoretical foundation and research methodology to understand the demand- and supply-side factors associated with screening and evaluate screening-related policies and interventions. This article provides an overview of health economic theories and methods related to cancer screening and discusses opportunities for future research. We review 2 academic disciplines most relevant to health economics research in cancer screening: applied microeconomics and decision science. We consider 3 emerging topics: cancer screening policies in national as well as local contexts, "choosing wisely" screening practices, and targeted screening efforts for vulnerable subpopulations. We also discuss the strengths and weaknesses of available data sources and opportunities for methodological research and training. Recommendations to strengthen research infrastructure include developing novel data linkage strategies, increasing access to electronic health records, establishing curriculum and training programs, promoting multidisciplinary collaborations, and enhancing research funding opportunities.

长期以来,癌症筛查一直被认为是一项值得投资的公共卫生事业。健康经济学为了解与筛查相关的供需因素以及评估与筛查相关的政策和干预措施提供了理论基础和研究方法。本文概述了与癌症筛查相关的卫生经济学理论和方法,并讨论了未来的研究机会。我们回顾了与癌症筛查中的卫生经济学研究最相关的两个学科:应用微观经济学和决策科学。我们考虑了 3 个新出现的主题:国家和地方背景下的癌症筛查政策、"明智选择 "筛查实践以及针对弱势亚人群的筛查工作。我们还讨论了现有数据源的优缺点以及方法研究和培训的机会。加强研究基础设施的建议包括:开发新的数据链接策略、提高电子健康记录的可及性、建立课程和培训计划、促进多学科合作以及增加研究资助机会。
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引用次数: 0
期刊
Journal of the National Cancer Institute. Monographs
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