Our purpose was to pilot a novel patient-centered financial navigation (FN) intervention to decrease the burden of financial toxicity (FT) among uninsured and underinsured patients with cancer treated at the North Carolina Cancer Hospital (NCCH). Methods: Participants were recruited by cancer clinic nurses and social workers at the NCCH. Eligible patients scored less than 22 points (indicating significant FT) on the COmprehensive Score for financial Toxicity (COST) instrument. Fifty patients were enrolled in the intervention, which included an intake assessment of financial needs and vulnerability, initial one-on-one consultation with a trained financial navigator (i.e., financial counselor or social worker), triage to financial support services matching patients' needs, and multiple follow-up appointments. Navigator recommendations were based upon a detailed review of patients' financial status, billing information, insurance, and other indicators used to refer patients to appropriate financial and social services resources offered by the hospital, government, nonprofits and private corporations. Following the initial appointment, patients were given a checklist of resources they were eligible for and the required paperwork to complete applications. During follow-up appointments, application status was reviewed, and practical assistance was provided. Patients were re-contacted at 2-week intervals to assess progress toward financial assistance goals. Outcome data collection included pre/post-intervention COST scores, patient satisfaction with the intervention, and intervention fidelity and retention. Results: The first fifty patients approached all screened positive for FT (COST < 22). Baseline COST scores ranged from 0–19. Results indicated a significant improvement in COST scores following the FN intervention (average increase = 6.86, 95% CI = 4.30–9.42), P < 0.0001). Post-intervention questionnaires indicated excellent patient satisfaction and retention with the FN intervention, and navigator logs indicated high fidelity to the intervention protocol. Conclusions: A novel FN intervention was feasible, acceptable, and effective in reducing FT among uninsured and underinsured oncology patients.

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model from the perspective of a US private insurance payer to evaluate the costeffectiveness of rituximab, tacrolimus, and cyclosporine in a hypothetical cohort of 1,000 patients with refractory MG, aged 20 years and above. We obtained disease transition probabilities, costs and outcomes data from the published literature. We calculated the incremental cost-effectiveness ratios (ICERs) as cost per quality-adjusted life-year (QALY) gained and cost per myasthenic crisis averted after the first two years of treatment and over a patient's lifetime. RESULTS: In the first two years after treatment rituximab is not cost-effective compared with cyclosporine, given an ICER of $368,823 per QALY gained. However, over a patient's lifetime rituximab has an ICER of $41,947 per QALY gained making it more costeffective than cyclosporine in the context of the commonly accepted US threshold of $50,000 per QALY gained. Tacrolimus is more costly and less effective than cyclosporine and rituximab both after two years of treatment and over a patient's lifetime. CONCLUSIONS: Assuming the benefits of treatment persist over time, rituximab is more cost-effective than cyclosporine over a patient's lifetime but not after two years of treatment under both the standard US threshold of $50,000 per QALY gained and an alternative higher threshold of $100,000 per QALY gained. Additional research is needed to evaluate the long-term benefits of rituximab.

These results include women of any age and mammography of any type. ConClusions: Results suggest that annual mammography is mostly cost-effective when compared to no screening. According to a $100,000/QALY threshold, most of analyzed studies suggest that combined screening is costeffective in high-risk women compared to mammography alone, despite a wide cost-effectiveness ratios range. Notwithstanding the high level of heterogeneity among selected studies, this review provides a comprehensive overview of the cost-effectiveness of BCS and could serve in the realization of future economic evaluations.