Objective Fear of cancer recurrence (FCR) is a common and burdensome psychological condition affecting cancer survivors. This systematic review aims to synthesise current evidence regarding: (1) FCR‐related healthcare usage and costs and (2) the cost‐effectiveness of FCR treatments. Methods We searched MEDLINE, CINAHL, Cochrane and other electronic databases using MeSH headings and keywords for cancer, FCR and costs from their inception to September 2019. Identified studies were screened for eligibility. Original, peer‐reviewed journal articles reporting quantitative data from samples of adults treated for cancer written in English were included. Quality was appraised using the Drummond checklist for economic evaluations or the relevant Joanna Briggs Institute Critical Appraisal Tool. Results Data from 11 studies were extracted and synthesised. Seven studies addressed the costs of FCR and suggested an increase in the use of primary and secondary healthcare. Four studies addressed the cost‐effectiveness of different FCR treatments and suggest that some treatments may cost‐effectively reduce FCR and improve quality of life. Reviewed treatments had an incremental cost‐effectiveness ratio between AU$3,233 and AU$152,050 per quality‐adjusted life year gained when adjusted to 2019 Australian dollars. All studies were of sufficient quality to be synthesised in this review. Conclusions FCR appears to be associated with greater use of certain healthcare resources, and FCR may be treated cost‐effectively. Thus, appropriate FCR treatments may not only reduce the individual burden, but also the strain on the healthcare system. Further high‐quality research is needed to confirm this and ensure the future implementation of efficient and sustainable FCR treatments.
support. In this review we explore the spectrum and consequences of malnutrition in differing 35 healthcare settings. We then specifically review gastrostomies as a method of providing 36 nutritional support. The review highlights the origins of gastrostomies, and discusses how 37 endoscopic and radiological advances have culminated in an increased demand and 38 placement of gastrostomy feeding tubes. Several studies have raised concerns about the 39 benefits derived following this intervention and also about the patients selected to undergo 40 this procedure. These studies are discussed in detail in this review, alongside suggestions for 41 future research to help better delineate those who will benefit most from this intervention, 42and improve understanding about how gastrostomies influence nutritional outcomes. 43 44 45
Aims Human health is intrinsically linked with planetary health. But planetary resources are currently being degraded and this poses an existential threat to human health and the sustainability of our healthcare systems. The aims of this study were to (1) describe an approach to integrate environmental impacts in a cost analysis; and (2) demonstrate this approach by estimating select environmental impacts alongside traditional health system and other costs using the example of the pilot MEL-SELF randomised controlled trial of patient-led melanoma surveillance. Methods Economic costs were calculated alongside a randomised trial using standard cost analysis methodology from a societal perspective. Environmental impacts were calculated using a type of carbon footprinting methodology called process-based life cycle analysis. This method considers three scopes of carbon emissions: Scope 1, which occur directly from the intervention; Scope 2, which occur indirectly from the intervention's energy use; and Scope 3, which occur indirectly because of the value chain of the intervention. In this study we only included emissions from patient transport to attend their melanoma clinic over the study period of 6 months. ResultsThe environmental impact per participant across allocated groups for patient transport to their melanoma clinic was estimated to be 10 kg carbon dioxide equivalent. Economic costs across the allocated groups indicated substantial health system costs, out-of-pocket costs, and productivity losses associated with melanoma surveillance. The largest cost contributor was health system costs, and the most expensive category of health system cost was hospital admission. Conclusion Calculating environmental impacts is worthwhile and feasible within a cost analysis framework. Further work is needed to address outstanding conceptual and practical issues so that a comprehensive assessment of environmental impacts can be considered alongside economic costs in health technology assessments.
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