Economic burden of managing oral cancer patients in Sri Lanka: a cross-sectional hospital -based costing study

Amarasinghe, Hemantha; Jayasinghe, Ruwan Duminda; Dharmagunawardene, Dilantha; Attygalla, Manjula; Scuffham, Paul Anthony; Johnson, Newell W.; Kularatna, Sanjeewa

doi:10.1136/bmjopen-2018-027661

Cited by 37 publications

(71 citation statements)

References 7 publications

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“…The cost of managing advanced stage cancer was found to be 42% greater than early stage tumours, with a 17% average increase in total unit cost as the stage progressed. These trends are similar to few other studies conducted around the world, showing that late stage disease disproportionally impacts budgets [ 28 – 31 ]. The need for composite surgery and adjuvant therapy increases proportionate to the stage of disease.…”

Section: Discussionsupporting

confidence: 89%

A prospective study to determine the cost of illness for oral cancer in India

Singh¹,

Chaukar²,

Gupta³

et al. 2021

ecancer

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India accounts for almost a third of the global burden of oral cancer, a situation worsened by the inability to afford care. When available, aid is often insufficient, and costing is based on informal estimations. This study objectively determines direct healthcare costs of oral cancer in India. The study was performed from a healthcare provider's perspective using a validated bottom-up method. Care pathways were determined by prospectively observing the natural management of 100 oral cancer patients treated between October 2019 and March 2020. Specific costing categories were built across services, and apportioned values for each interaction was averaged. Costs of treatment and service utilisation were obtained using probabilistic sensitivity analyses. The unit cost of treating advanced stages (United States Dollar (USD) 2,717) was found to be 42% greater than early stages (USD1,568). There was an 11% reduction in unit costs with increases in socioeconomic status. Medical equipment accounted for 97.8% of capital costs, with the highest contributor being imaging services. Variable costs for surgery in advanced stages were 1.4 times higher than early stages. Compared to surgery alone, the average cost of treatment increased by 44.6% with adjuvant therapy. These results show that over the next decade, India will incur an economic burden of USD 3 billion towards the direct healthcare of oral cancer. Early detection and prevention strategies leading to 20% reduction in advanced stage disease could save USD 30 million annually. These results are critical to deliver a disease-driven and objective reform for oral cancer care.

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Section: Discussionsupporting

confidence: 89%

A prospective study to determine the cost of illness for oral cancer in India

Singh¹,

Chaukar²,

Gupta³

et al. 2021

ecancer

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“…Treating Stage III and IV cancers were more expensive in the initial phase and gave rise to higher expenditure over the total management period relative to early-stage cancer and OPMD. Our results notably echoed the findings from numerous studies worldwide illustrating the higher economic burden of treating late-stage oral cancer [ 28 , 33 , 35 , 37 ]. The global trend was generally due to a higher percentage of multimodal cancer treatment and extended hospitalization in later stages.…”

Section: Discussionsupporting

confidence: 87%

“…The selection of analytical methods to generate mean healthcare cost is critical, especially to project exact and precise values. The standard in cost analysis will be the enumeration of a sufficiently powered sample size over one year [ 23 , 28 , 35 ]. Such practice provides an accurate annual cost and distribution while avoiding the difficulty of censored cases.…”

Section: Discussionmentioning

confidence: 99%

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Provider cost of treating oral potentially malignant disorders and oral cancer in Malaysian public hospitals

et al. 2021

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Oral cancer has been recognized as a significant challenge to healthcare. In Malaysia, numerous patients frequently present with later stages of cancers to the highly subsidized public healthcare facilities. Such a trend contributes to a substantial social and economic burden. This study aims to determine the cost of treating oral potentially malignant disorders (OPMD) and oral cancer from a public healthcare provider’s perspective. Medical records from two tertiary public hospitals were systematically abstracted to identify events and resources consumed retrospectively from August 2019 to January 2020. The cost accrued was used to estimate annual initial and maintenance costs via two different methods- inverse probability weighting (IPW) and unweighted average. A total of 86 OPMD and 148 oral cancer cases were included. The initial phase mean unadjusted cost was USD 2,861 (SD = 2,548) in OPMD and USD 38,762 (SD = 12,770) for the treatment of cancer. Further annual estimate of initial phase cost based on IPW method for OPMD, early and late-stage cancer was USD 3,561 (SD = 4,154), USD 32,530 (SD = 12,658) and USD 44,304 (SD = 16,240) respectively. Overall cost of late-stage cancer was significantly higher than early-stage by USD 11,740; 95% CI [6,853 to 16,695]; p< 0.001. Higher surgical care and personnel cost predominantly contributed to the larger expenditure. In contrast, no significant difference was identified between both cancer stages in the maintenance phase, USD 700; 95% CI [-1,142 to 2,541]; p = 0.457. A crude comparison of IPW estimate with unweighted average displayed a significant difference in the initial phase, with the latter being continuously higher across all groups. IPW method was shown to be able to use data more efficiently by adjusting cost according to survival and follow-up. While cost is not a primary consideration in treatment recommendations, our analysis demonstrates the potential economic benefit of investing in preventive medicine and early detection.

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“…Oral cancer is typically associated with late presentation, particularly in LMICs, where more than two-thirds present at late stages and as a result survival rates are poor [4]. Management of cancers, especially at the late stages, is very costly [5]. The lack of public awareness and the lack of knowledge of health professionals concerning oral cancer is an important reason for late detection [6].…”

Section: Introductionmentioning

confidence: 99%

Automated Detection and Classification of Oral Lesions Using Deep Learning for Early Detection of Oral Cancer

et al. 2020

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Oral cancer is a major global health issue accounting for 177,384 deaths in 2018 and it is most prevalent in low-and middle-income countries. Enabling automation in the identification of potentially malignant and malignant lesions in the oral cavity would potentially lead to low-cost and early diagnosis of the disease. Building a large library of well-annotated oral lesions is key. As part of the MeMoSA ® (Mobile Mouth Screening Anywhere) project, images are currently in the process of being gathered from clinical experts from across the world, who have been provided with an annotation tool to produce rich labels. A novel strategy to combine bounding box annotations from multiple clinicians is provided in this paper. Further to this, deep neural networks were used to build automated systems, in which complex patterns were derived for tackling this difficult task. Using the initial data gathered in this study, two deep learning based computer vision approaches were assessed for the automated detection and classification of oral lesions for the early detection of oral cancer, these were image classification with ResNet-101 and object detection with the Faster R-CNN. Image classification achieved an F1 score of 87.07% for identification of images that contained lesions and 78.30% for the identification of images that required referral. Object detection achieved an F1 score of 41.18% for the detection of lesions that required referral. Further performances are reported with respect to classifying according to the type of referral decision. Our initial results demonstrate deep learning has the potential to tackle this challenging task. INDEX TERMS Composite annotation, deep learning, image classification, object detection, oral cancer, oral potentially malignant disorders.

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Economic burden of managing oral cancer patients in Sri Lanka: a cross-sectional hospital -based costing study

Cited by 37 publications

References 7 publications

A prospective study to determine the cost of illness for oral cancer in India

A prospective study to determine the cost of illness for oral cancer in India

Provider cost of treating oral potentially malignant disorders and oral cancer in Malaysian public hospitals

Automated Detection and Classification of Oral Lesions Using Deep Learning for Early Detection of Oral Cancer

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