In an era of health reform: Defining cost differences in current esophageal cancer management strategies and assessing the cost of complications

Kuppusamy, MadhanKumar; Sylvester, Julie; Low, Donald E.

doi:10.1016/j.jtcvs.2010.09.011

Cited by 20 publications

(17 citation statements)

References 22 publications

(40 reference statements)

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“…Our results were compatible with previous randomized trials and population‐based studies, in that NCCRT was effective in improving survival . Our results were also consistent with previous studies in that NCCRT was associated with increased cost . Furthermore, to the best of our knowledge, our study is the first to provide an estimate of cost‐effectiveness of NCCRT.…”

Section: Discussionsupporting

confidence: 92%

“…In the literature, neoadjuvant therapy (such as NCCRT) has been associated with improved survival for resectable esophageal cancer when compared to surgery, and may or may not increase the risk of postoperative morbidity . Neoadjuvant therapy is also associated with increased cost . However, there is a paucity of cost‐effectiveness analysis (CEA) regarding NCCRT in esophageal cancer, which is highly desirable in an era of increasing health care costs and the desire for affordable cancer care .…”

Section: Introductionmentioning

confidence: 99%

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Cost‐effectiveness of neoadjuvant concurrent chemoradiotherapy versus esophagectomy for locally advanced esophageal squamous cell carcinoma: A population‐based matched case‐control study

et al. 2015

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BackgroundNeoadjuvant concurrent chemoradiotherapy (NCCRT) is often considered for locally‐advanced esophageal squamous cell carcinoma (LA‐ESCC) patients; however, no data regarding the cost‐effectiveness of this treatment is available. Our study aimed to evaluate the cost‐effectiveness of NCCRT versus esophagectomy for LA‐ESCC at population level.MethodsWe identified LA‐ESCC patients diagnosed within 2008–2009 and treated with either NCCRT or esophagectomy through the Taiwan Cancer Registry. We included potential confounding covariables (age, gender, residency, comorbidity, social‐economic status, disease stage, treating hospital level and surgeon's experience, and the use of endoscopic ultrasound before treatment) and used propensity score (PS) to construct a 1:1 population. The duration of interest was three years within the date of diagnosis. Effectiveness was measured as overall survival. We took the payer's perspective and converted the cost to 2014 United States dollars (USD). In sensitivity analysis, we evaluated the potential impact of an unmeasured confounder on the statistical significance of incremental net benefit at suggested willingness‐to‐pay.ResultsOur study population constituted 150 PS matched subjects. The mean cost (2014 USD) and survival (year) were higher for NCCRT compared with esophagectomy (US$91,460 vs. $75,836 for cost; 2.2 vs. 1.8 for survival) with an estimated incremental cost‐effectiveness ratio of US$39,060/life‐year.ConclusionsWhen compared to esophagectomy, NCCRT is likely to improve survival and is probably more cost‐effective. Cost‐effectiveness results should be interpreted with caution given our results were sensitive to potential unmeasured confounder(s) in sensitivity analysis.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of neoadjuvant concurrent chemoradiotherapy versus esophagectomy for locally advanced esophageal squamous cell carcinoma: A population‐based matched case‐control study

et al. 2015

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“…We showed that there is a statistically significant difference in total hospital costs for patients who developed major complications. Kuppusamy et al also showed a difference in costs between patients who developed complications and who did not develop complications undergoing esophageal resection [ 21 ]. However, the study population consisted of four small groups of 15 patients undergoing different treatment regimens.…”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life and hospital costs following esophageal resection: a prospective cohort study

et al. 2015

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BackgroundThe incidence rates for adenocarcinoma of the esophagus are increasing while the prognosis has only improved slightly. There is no apparent benefit in short- and long-term survival after different surgical strategies, but surgery is associated with significant morbidity. The goal of this study is to prospectively assess the quality of life and hospital costs after esophageal resections depending on the development of complications.MethodsProspective data was collected from 47 patients undergoing an esophageal resection for esophageal cancer participating in the prospective LAParotomy or LAParoscopy and Adhesions (LAPAD) study (clinicaltrials.gov registration number: NCT01236625). A comparison was made between patients who developed major complications and minor or no complications regarding quality of life and hospital costs.ResultsThirteen patients developed major complications while 34 patients developed only minor or no complications. Patients with major complications had a mean hospital cost of $16,369 vs $12,409 for patients without or with minor complications. We found no difference in quality of life between the two groups 6 months after surgery.ConclusionsIn our cohort, major complications did not seem to have a detrimental effect on postoperative quality of life 6 months after surgery but they increased costs associated with esophageal resection.

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“…The system tracks actual costs but has an 18-month delay until data are complete. That enabled us to examine specific actual costs in our different treatment groups [12].…”

Section: Methodsmentioning

confidence: 99%

Accelerated Recovery Within Standardized Recovery Pathways After Esophagectomy: A Prospective Cohort Study Assessing the Effects of Early Discharge on Outcomes, Readmissions, Patient Satisfaction, and Costs

Schmidt

Lakis

Markar

et al. 2016

The Annals of Thoracic Surgery

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In an era of health reform: Defining cost differences in current esophageal cancer management strategies and assessing the cost of complications

Cited by 20 publications

References 22 publications

Cost‐effectiveness of neoadjuvant concurrent chemoradiotherapy versus esophagectomy for locally advanced esophageal squamous cell carcinoma: A population‐based matched case‐control study

Cost‐effectiveness of neoadjuvant concurrent chemoradiotherapy versus esophagectomy for locally advanced esophageal squamous cell carcinoma: A population‐based matched case‐control study

Health-related quality of life and hospital costs following esophageal resection: a prospective cohort study

Accelerated Recovery Within Standardized Recovery Pathways After Esophagectomy: A Prospective Cohort Study Assessing the Effects of Early Discharge on Outcomes, Readmissions, Patient Satisfaction, and Costs

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