Julie Hallet1,2,3,4, Nicole J Look Hong5,6,7,8, Victoria Zuk7, Laura E Davis7, Vaibhav Gupta6, Craig C Earle7,9, Nicole Mittmann7, Natalie G Coburn5,6,7,8. 1. Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075, Bayview Avenue, T2-063, Toronto, ON, M4N 3M5, Canada. Julie.hallet@sunnybrook.ca. 2. Department of Surgery, University of Toronto, Toronto, ON, Canada. Julie.hallet@sunnybrook.ca. 3. Sunnybrook Research Institute, Toronto, ON, Canada. Julie.hallet@sunnybrook.ca. 4. ICES, Toronto, ON, Canada. Julie.hallet@sunnybrook.ca. 5. Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075, Bayview Avenue, T2-063, Toronto, ON, M4N 3M5, Canada. 6. Department of Surgery, University of Toronto, Toronto, ON, Canada. 7. Sunnybrook Research Institute, Toronto, ON, Canada. 8. ICES, Toronto, ON, Canada. 9. Department of Medicine, University of Toronto, Toronto, ON, Canada.
Abstract
BACKGROUND: Esophagogastric cancer (EGC) is one of the deadliest and costliest malignancies to treat. Care by high-volume providers can provide better outcomes for patients with EGC. Cost implications of volume-based cancer care are unclear. We examined the cost-effectiveness of care by high-volume medical oncology providers for non-curative management of EGC. METHODS: We conducted a population-based cohort study of non-curative EGC over 2005-2017 by linking administrative datasets. High-volume was defined as ≥ 11 patients/provider/year. Healthcare costs ($USD/patient/month-survived) were computed from diagnosis to death or end of follow-up from the perspective of the healthcare system. Multivariable quantile regression examined the association between care by high-volume providers and costs. Sensitivity analyses were conducted by varying costing horizons and high-volume definitions. RESULTS: Among 7011 non-curative EGC patients, median overall survival was superior with care by high-volume providers with 7.0 (IQR 3.3-13.3) compared to 5.9 (IQR 2.6-12.1) months (p < 0.001) for low-volume providers. Median costs/patient/month-lived were lower for high-volume providers ($5518 vs. $5911; p < 0.001), owing to lower inpatient acute care costs, despite higher medication-associated and radiotherapy costs. Care by high-volume providers was independently associated with a reduction of $599 per patient/month-lived (95% confidence interval - 966 to - 331) compared to low-volume providers. The incremental cost-effectiveness ratio was - 393. Care by high-volume providers remained the dominant strategy when varying the costing horizon and the high-volume definition. CONCLUSION: Care by high-volume providers for non-curative EGC is associated with superior survival and lower healthcare costs, indicating a dominant strategy that may provide an opportunity to improve cost-effectiveness of care delivery.
BACKGROUND:Esophagogastric cancer (EGC) is one of the deadliest and costliest malignancies to treat. Care by high-volume providers can provide better outcomes for patients with EGC. Cost implications of volume-based cancer care are unclear. We examined the cost-effectiveness of care by high-volume medical oncology providers for non-curative management of EGC. METHODS: We conducted a population-based cohort study of non-curative EGC over 2005-2017 by linking administrative datasets. High-volume was defined as ≥ 11 patients/provider/year. Healthcare costs ($USD/patient/month-survived) were computed from diagnosis to death or end of follow-up from the perspective of the healthcare system. Multivariable quantile regression examined the association between care by high-volume providers and costs. Sensitivity analyses were conducted by varying costing horizons and high-volume definitions. RESULTS: Among 7011 non-curative EGCpatients, median overall survival was superior with care by high-volume providers with 7.0 (IQR 3.3-13.3) compared to 5.9 (IQR 2.6-12.1) months (p < 0.001) for low-volume providers. Median costs/patient/month-lived were lower for high-volume providers ($5518 vs. $5911; p < 0.001), owing to lower inpatient acute care costs, despite higher medication-associated and radiotherapy costs. Care by high-volume providers was independently associated with a reduction of $599 per patient/month-lived (95% confidence interval - 966 to - 331) compared to low-volume providers. The incremental cost-effectiveness ratio was - 393. Care by high-volume providers remained the dominant strategy when varying the costing horizon and the high-volume definition. CONCLUSION: Care by high-volume providers for non-curative EGC is associated with superior survival and lower healthcare costs, indicating a dominant strategy that may provide an opportunity to improve cost-effectiveness of care delivery.
Authors: Scott R Berry; Chaim M Bell; Peter A Ubel; William K Evans; Eric Nadler; Elizabeth L Strevel; Peter J Neumann Journal: J Clin Oncol Date: 2010-08-09 Impact factor: 44.544
Authors: Nicole Mittmann; Craig C Earle; Stephanie Y Cheng; Jim A Julian; Farah Rahman; Soo Jin Seung; Mark N Levine Journal: J Clin Oncol Date: 2017-12-01 Impact factor: 44.544
Authors: John D Birkmeyer; Therese A Stukel; Andrea E Siewers; Philip P Goodney; David E Wennberg; F Lee Lucas Journal: N Engl J Med Date: 2003-11-27 Impact factor: 91.245
Authors: Julie Hallet; Laura E Davis; Alyson L Mahar; Ying Liu; Victoria Zuk; Vaibhav Gupta; Craig C Earle; Natalie G Coburn Journal: Gastric Cancer Date: 2019-10-18 Impact factor: 7.370
Authors: Catherine Ireland; Eric Wiedower; Muhammad Mirza; Melissa Crawley; Alexandria Tran; George Yaghmour; Mike G Martin Journal: World J Oncol Date: 2018-05-01