AB064. Estimation of direct and indirect costs and quality of life of patients with chronic obstructive pulmonary disease and their burden on Greek Health System

Abstract

Background: Lung cancer remains the leading cause of cancer-related deaths worldwide and novel therapeutic approaches targeting crucial pathways are urgently needed to improve its treatment. Differentiation-based therapeutics (Methylxanthines) and phosphodiesterase inhibitors (type 4 and 5), have been implicated in cancer treatment. Our objectives were to capture any potential anti-tumor effect of these drug combinations with chemotherapeutic agents in vitro. Methods: Theophylline as Methylxanthines, Roflumilast as phosphodiesterase type 4 (PED-4) inhibitor and Sildenafil as phosphodiesterase type 5 (PED-5) inhibitor are the drugs that we combined with the chemotherapeutic agents (Docetaxel, Cisplatin and Carboplatin) in vitro. Lung cancer cell lines (NCI-H1048-small cell lung cancer, A549-nonsmall cell lung cancer) were purchased from ATCC LGC Standards. At indicated time-point, following 24 and 48 h incubation, cell viability and apoptosis were measured with Annexin V staining by flow cytometry. Statistical analysis was performed by GraphPad Prism. Results: In Small cell lung cancer cells, following 48 h incubation, combinations of carboplatin and roflumilast (P<0.05), carboplatin with roflumilast and sildenafil (P<0.0001), carboplatin with theophylline and sildenafil (P<0.001), showed increased apoptosis when compared to carboplatin alone. The only combination that showed increased apoptosis following 24 h incubation was carboplatin with theophylline (P<0.0001). Moreover, cisplatin combined with roflumilast, theophylline and sildenafil resulted in increased apoptosis after 48 h incubation when compared with cisplatin alone (P<0.05). In non-small cell lung cancer cells, the 24 h incubation was not enough to induce satisfactory apoptosis, except for the combination of cisplatin with roflumilast and theophylline. However, following 48 h incubation, carboplatin plus sildenafil, carboplatin plus sildenafil, theophylline and roflumilast showed more cytotoxicity when compared to carboplatin alone (P<0.001). In addition, the combination of docetaxel plus theophylline and roflumilast was found with higher cytotoxicity when compared to docetaxel alone after 48 h treatment (P<0.001). Conclusions: Depending on the drug, the synergistic effect of PED-4 and PED-5 inhibitors plus theophylline with chemotherapeutic agents has been demonstrated in lung cancer. Our suggestion is that these combinations could be used as additive and maintenance treatment in combination to antineoplastic agents in lung cancer patients.

End-of-Life Health-Care Cost of Patients With Lung Cancer: A Retrospective Study

“…From a review of the literature to date, only a limited number of published studies have focused on the costs of terminal-phase lung cancer care. In the Greek context, a recently published prospective study 20 estimated the costs of patients with lung cancer for a period of 32 months from diagnosis to the end of registry and found that the cost of chemotherapy was the main cost driver, a finding consistent with the findings of our study, while the indirect cost was higher for patients than their caregivers. However, the clinical procedures used during treatment of patients with end-stage lung cancer were not recorded and their direct medical costs not estimated.…”

“…Recently, a prospective analysis estimated the direct and indirect costs of lung cancer incurred in a Greek University Pulmonary Department with chemotherapy drugs constituting the highest factor of total direct cost. 20 In the latter study, the health-care costs for patients with end-stage lung cancer during the last months of life were not estimated. In 2011, a nationwide study calculated hospital costs for the treatment of smoking-attributable diseases in Greece and demonstrated that lung cancer–related costs for that year were approximately €38.2 million.…”

Estimating time and transportation costs associated with lung cancer screening and diagnostic lung procedures in Taiwan: a cross-sectional survey in a medical centre

“…We found that a participant’s lost days of productivity were longer than those of the family caregiver during the phase of diagnosis. The results were different from a previous study 26. This finding could be partially explained by the low employment rate of family caregivers.…”

“…Although prior research had estimated non-medical costs for breast cancer screening, cervical cancer screening and colon cancer screening,8–11 most studies evaluated the time costs related to lost work days and transportation costs among lung cancer survivors after cancer diagnosis 12 25–27. Cressman et al estimated the time and transportation costs associated with lung cancer screening in the PanCan study 14.…”

“…The results were different from a previous study. 26 This finding could be partially explained by the low employment rate of family caregivers. For example, the employment rates of participants undergoing non-surgical procedures and surgical procedures were 33.3% and 27.4%, respectively (table 1), whereas those of the family caregivers appeared to be similar (41.7% for non-surgical procedure group and 38.1% for surgical procedure group).…”