The effectiveness of three methods of assessing the patient body burden following 131I therapy was compared: (a) urine assay, (b) external exposure rate measurements, and (c) predictions based on a pretherapy diagnostic work-up. The urine assay method exhibited the greatest potential for error and personnel risk. The diagnostic work-up provided predictions of the body burden as a function of time, which may be applied to estimate the expected hospital stay. The direct external exposure rate survey showed the potential for being an accurate, reliable, and relatively safe method of monitoring the patient body burden.
Background/Objective Adherence to recommended care remains challenging for patients with breast cancer (BC), particularly those from disadvantaged groups. Although our Center has historically used lay BC navigators to meet with newly diagnosed patients, our team identified the need to improve care for vulnerable cancer patients (pts) through nurse (RN) navigators. This project aimed to investigate adherence to care over two-time intervals, pre and post RN navigators, and investigate the level of out migration (patients who leave our system) of BC patients during the same time. Methods An RN breast oncology navigator started navigating patients and collecting data on Jan 1st, 2018. The RN navigator meets with all newly diagnosed BC pts during clinic and tracks their progression of care, often expediting work up and treatment. A tumor registry audit of refusal of care as coded by “pt or pt guardian refused care” was conducted for two-time intervals: 2016-2017 (pre-RN navigation) and 2018-2019 (post-RN navigation). Out-migration of analytic BC patients was also measured during these time intervals. Results The tables below show total analytic cases and refusal of care rates. Refusal of care rates decreased from 17.8% pre- to 13.2% post-RN navigation. Out-migration was 3.6% for 2016-2017 and 3.6% for 2018-2019. Conclusions Implementation of an RN breast navigator in 2018 trended towards less refusal of care by our patients diagnosed or receiving at least one treatment in our safety net hospital. Refusing chemotherapy and hormonal therapy were treatments that were most impacted by RN breast navigation. RN navigation may enhance compliance through: offering personalized education, dispelling myths of therapy, proactively working with patients when side effects/complications occur, and supporting patients when questions or concerns arise. While there was no difference in “out-migration” to other cancer centers identified during this time interval, the number of patients leaving the system remains low. We plan to continue to track our BC navigated patients and collect patient satisfaction with navigation as a future initiative. This effort was supported by a grant from the Merck Foundation Alliance to Advance Patient-Centered Cancer Care. Table 1: Total BC pts and refusal of careBC Patients2016-2017(Pre RN navigation)2018-2019(Post RN navigation)P-valueTotal analytic325376Total Refusal of care58 (17.8%)50 (13.2%)0.128 Table 2: Refusal by type of recommended careTime IntervalChemoHormonalImmunotherapyRadiationSurgery2016-201729(62%)18(60%)0(0%)22 (48%)10(45%)2018-201918(38%)12 (40%)2 (100%)24(52%)12(55%) Citation Format: Christine Rehr, Susan Coples, Zhensheng Wang, Roland Matthews, Pooja Mishra, Jamil Facdol, Rosalyn Garrett, Kimberly Fritz, Sheryl Gabram. The impact of nurse navigation on adherence to care for patients treated for breast cancer in a safety net hospital [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-58.
To perform a treatment cost comparison of pirfenidone versus nintedanib on the treatment of idiopathic pulmonary fibrosis (IPF) under the Brazilian private healthcare system perspective. MethOds: Both treatment's ex-factory prices were obtained from official published lists, by the Brazilian Ministry of Health, considering the incidence of taxes (ICMS 18%). Annual treatment cost was calculated based on the dosage of pirfenidone (2.403 mg/day) and nintedanib (150 mg BID) obtained from their respective Brazilian labels. A year was assumed to be 12 months with 30 days each. Results were shown for 2 scenarios: first year (including initial dose ramp up for pirfenidone) and maintenance phases. Results: Pirfenidone and nintedanib unitary costs were BRL 9,144 (BRL 33.87 per 267 mg tablet) and BRL 14,916 (BRL 248.60 per 150 mg tablet), respectively, according to their list prices. Pirfenidone showed an annual treatment cost of BRL 107,591 and BRL 109,724 on the first year and subsequent years of treatment, respectively. Nintedanib incurred an annual cost of BRL 178,988 independent of year of treatment. Those results led to savings of approximately BRL 70,000 per year per patient treated with pirfenidone compared to those treated with nintedanib (a relative reduction of approximately 40%). Pirfenidone's dose ramp up, on the first year of treatment, did not decrease significantly the treatment cost, implying on a reduction of just 2% when compared to subsequent years. cOnclusiOns: Pirfenidone was lower than the cost of nintedanib.
Objectives: To assess the healthcare resource utilization and cost associated with the inpatient treatment of short-acting intramuscular (IM) ziprasidone, oral risperidone + oral benzodiazepine, oral olanzapine, short-acting IM haloperidol, and electroconvulsive therapy (ECT) for the management of acute agitation among patients with schizophrenia in China from a hospital's perspective. MethOds: Cost measures included hospital room and board, antipsychotics, ECT, and medications for the management of extrapyramidal symptoms (EPS). Input for standard antipsychotic regimens and unit cost were obtained from literature. Hospital length of stay (LOS), utilization of ECT, and incidence of EPS were derived from the literature and supplemented/validated with a survey of 9 psychiatrists in China. Cost was presented in 2017 RMB (¥). Results: Based on the survey, the average (range) estimated LOS was 29 (14-42) days with ziprasidone, 33 (15-60) days with risperidone + benzodiazepine, 32 (15-50) days with olanzapine, 35 (25-50) days with haloperidol, and 29 (12-42) days with ECT. The cost of antipsychotics was ¥1,261 with ziprasidone, ¥137 with risperidone + benzodiazepine, ¥913 with olanzapine, ¥210 with haloperidol; ECT treatment cost ¥1,585. The base-case analysis suggested that higher antipsychotic cost with ziprasidone was offset by savings with shorter LOS. Total costs including all the cost measures during the inpatient stay was the lowest with ziprasidone among all regimens (¥11,157 with ziprasidone, ¥11,406 with ECT, ¥11,422 with risperidone plus benzodiazepine, ¥11,711 with olanzapine, and ¥11,923 with haloperidol). The cost of antipsychotics and ECT accounted for 1.2% to 13.9% of the total cost. Varying LOS between the lower and upper bounds of the 95% confidence interval, total cost was comparable between these regimens. cOnclusiOns: Overall, the cost for the management of acute agitation was similar between IM ziprasidone and other antipsychotics. Compared to other antipsychotics, higher medication cost of IM ziprasidone can be offset by savings with shorter hospital stay.
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