No abstract

BackgroundTherapies for invasive breast cancer may be associated with an incremental survival advantage that should be weighed against the risk of toxicities when making treatment decisions. The objective of this study was to elicit patient preferences for a comprehensive profile of attributes associated with chemotherapies for breast cancer.MethodsThis was a cross-sectional study of 121 patients with stage I-IV breast cancer who completed an internet-based conjoint survey that assessed the following attributes: ten grade III/IV toxicities, survival advantage, and administration regimen. Literature and expert input were used to identify descriptions for each attribute and respective levels (eg, different risks of toxicities). Subjects rated the attribute levels on a series of scales and indicated preferences in pair-wise comparisons of two hypothetical treatments differing in attribute levels. Ordinary least-squares regression was used to calculate utilities (preference weights) for each attribute level.ResultsOf the twelve attributes, survival was the most important; specifically, a survival advantage of 3 months versus no survival advantage was most influential in the perceived value of chemotherapy. Among toxicities, the differences in the risks of neutropenia with hospitalization, diarrhea, nausea, and fatigue had the most impact on preferences; the risk differences of myalgia, stomatitis, and hand-foot syndrome had the least. In general, a more convenient administration regimen was less important than a 13% chance or more of severe toxicities, but more important than a 10%–12% chance of severe toxicities.ConclusionBreast cancer patients place high value on small incremental survival advantages associated with treatment despite the risk of serious toxicities.

No abstract

No abstract

The objective of this study is to describe a disease management programme (DMP) for the bleeding disorder population insured by Indiana's high-risk insurance plan, and to assess the associated costs and outcomes. All bleeding disorder patients, covered by the state plan as their primary health insurance, were enrolled into a DMP administered by the Indiana Hemophilia & Thrombosis Center (IHTC). A pre/post-intervention study design was used, with 1-year pre-enrollment serving as the baseline period and 1-year post-enrollment as the study period. Claims data were used to assess hospitalizations, emergency room (ER) visits, total medical and clotting factor costs and factor units dispensed. Medical records were used to assess disease severity and other comorbidities. Thirty-one continuously enrolled patients had complete data over 2 years. Approximately 84% of the population was male, 81% with haemophilia. The average costs of care in the baseline year and the first year of the programme were $161 441 and $118 293, respectively. The decrease in the total costs was primarily attributed to a decrease in outpatient factor costs, which resulted from decreased factor utilization and lower per unit factor costs. The mean number of inpatient hospital days and ER visits for the DMP population decreased from 1.3 and 1.4 to 0.4 and 0.6, baseline and first year, respectively. Owing to the small sample size and high variability of the population, the differences were not statistically significant. The DMP appears to have reduced the total costs and resource utilization, although the study was underpowered.