An inverse stage‐shift model to estimate the excess mortality and health economic impact of delayed access to cancer services due to the COVID‐19 pandemic

Abstract

Aim Decreased cancer incidence and reported changes to clinical management indicate that the COVID‐19 pandemic has delayed cancer diagnosis and treatment. This study aimed to develop and apply a flexible model to estimate the impact of delayed diagnosis and treatment on survival outcomes and healthcare costs based on a shift in the disease stage at treatment initiation. Methods A model was developed and made publicly available to estimate population‐level health economic outcomes by extrapolating and weighing stage‐specific outcomes by the distribution of stages at treatment initiation. It was applied to estimate the impact of 3‐ and 6‐month delays based on Australian data for stage I breast cancer, colorectal cancer, and lung cancer patients, and for T1 melanoma. Two approaches were explored to estimate stage shifts following a delay: (a) based on the relation between time to treatment initiation and overall survival (breast, colorectal, and lung cancer), and (b) based on the tumor growth rate (melanoma). Results Using a conservative once‐off 3‐month delay and considering only shifts from stage I/T1 to stage II/T2, 88 excess deaths and $12 million excess healthcare costs were predicted in Australia over 5 years for all patients diagnosed in 2020. For a 6‐month delay, excess mortality and healthcare costs were 349 deaths and $46 million over 5 years. Conclusions The health and economic impacts of delays in treatment initiation cause an imminent policy concern. More accurate individual patient data on shifts in stage of disease during and after the COVID‐19 pandemic are critical for further analyses.

Consequences of the COVID-19 Pandemic and Governmental Containment Policies on the Detection and Therapy of Oral Malignant Lesions—A Retrospective, Multicenter Cohort Study from Germany

“…A study by Riemann gave evidence that-in Germany-contacts with the primary care physician dropped by up to 70% during the lockdown in 2020. In addition, gastroenterologists experienced a massive cancellation of appointments for elective examinations and a reduction in the number of appointments for preventive examinations [27].…”

O Melanoma pode esperar o Fim da Pandemia da Covid-19?

“…Negligenciar o melanoma durante a pandemia pode resultar em aumento da mortalidade e morbidade, além de maiores custos de saúde 5 . Em estudo recente, Degeling et al 6 avaliaram a progressão de determinadas neoplasias em virtude do atraso diagnóstico durante a pandemia e os impactos econômicos do diagnóstico e tratamento tardio. Nesse trabalho, as probabilidades de progressão tumoral do melanoma por conta de um atraso de três a seis meses foram de 32,0% e 64,0%, respectivamente, o que demonstra uma progresssão muito rápida dessa neoplasia.…”

“…Além disso, houve uma importante redução de sobrevida em cinco anos em razão do atraso diagnóstico, tendo sido o melanoma a neoplasia que apresentou maior impacto na sobrevida. Essse estudo também demonstrou, com base na mudança de estágio clínico por progressão da doença, que os custos de saúde para o tratamento de melanoma apresentam um aumento expressivo com o atraso diagnósticos ocasionado pela pandemia 6 . Assim, tendo em vista o impacto expressivo no diagnóstico de melanoma no período analisado neste estudo, é necessário questionar o impacto que esse atraso pode gerar ao prognóstico dos pacientes acometidos pela afecção.…”

Lessons Learned in Managing Patients with Colorectal Cancer During the COVID-19 Pandemic

“…Mandated colonoscopy cancelations and delays raise concerns about missing early CRC diagnoses in populations. Estimation models suggest delays in colonoscopy screening up to 12 months after a positive fecal immunochemical test (FIT) result in loss of screening benefit, and early prediction models in response to COVID-19 suggest a 6-month delay would result in stage I to II progression in 3% of patients [37,38]. Other prediction models estimate an excess of over 4000 CRC deaths over the next 10 years due to the pandemic impacts on screening [39].…”