Economic Evaluation of a Geriatric Oncology Clinic

Abstract

Geriatric assessment (GA) is supported by recent trials and guidelines yet rarely implemented due to a lack of resources. We performed an economic evaluation of a geriatric oncology clinic. Pre-GA proposed treatments and post-GA actual treatments were obtained from a detailed chart review of patients seen at a single academic centre. GA-based costs for investigations and referrals were calculated. Unit costs were obtained for surgical, radiation, systemic therapy, laboratory, imaging, physician, nursing, and allied health care (all in 2019 Canadian dollars). A six-month time horizon and government payer perspective were used. Consecutive patients aged 65 years or older (n = 152, mean age 82 y) and referred in the pre-treatment setting between July 2016 and June 2018 were included. Treatment plans were modified for 51% of patients. Costs associated with planned treatment were CAD 3,655,015. Costs associated with GA and related interventions were CAD 95,798. Final treatment costs were CAD 2,436,379. Net savings associated with the clinic were CAD 1,122,837, or CAD 7387 per patient seen. Findings were robust in multiple sensitivity analyses. Combined with mounting trial data demonstrating the clinical benefits of GA, our data can inform a strong business case for geriatric oncology clinics in health care environments similar to ours, but additional studies in diverse health care settings are warranted.

Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in older people with cancer starting systemic anticancer treatment in Australia: a multicentre, open-label, randomised controlled trial

“…Despite potential savings associated with CGA to offset intervention costs, it might not be feasible for every older person with cancer being planned for treatment to have a comprehensive assessment by a geriatrician in the context of a finite geriatrician workforce. 41 Therefore, incorporating strategies, such as routine geriatric screening, digital data collection, and adding nursing or allied health staff to the process, could enhance resource allocation and long-term sustainability in the broader implementation of the integrated oncogeriatric care model. 2,12 This study has several strengths.…”

Integrating what matters to patients in the care of older adults with cancer

“…Although financial savings have already been shown after the establishment of a geriatric oncology clinic in a cancer centre (Princess Margaret Cancer Centre, Toronto, ON, Canada), 10 more research is needed on the cost-effectiveness of oncogeriatric care models in a broader range of health-care settings and in more diverse geographical areas. Continuity of care between hospital and community services is crucial when caring for older adults with cancer.…”

Cost-Utility Analysis of Geriatric Assessment and Management in Older Adults With Cancer: Economic Evaluation Within 5C Trial

“…Unit costs for geriatrician (Data Supplement, Table S2) and other physician consultations, laboratory tests, and procedures were assigned from the Ontario Schedule of Benefits for Physician Services, 22 while hourly labor costs for nurses and allied health specialists were obtained from the hospital financial records. 23 Unit costs for ED and hospital admissions were obtained using the 2019-2020 Patient Cost Estimator by the Canadian Institute for Health Information and selecting case mix groups for Ontario elderly population and respective cause of hospitalization. 24 Unit costs of chemotherapy medications were obtained from multiple sources.…”

“…24 Unit costs of chemotherapy medications were obtained from multiple sources. 23,25,26 The costs for radiation therapy incorporated fixed costs for supporting infrastructure (eg, computed tomography simulation, dosimetry planning, and quality assurance by physicists) and per-fraction cost for treatment delivery. 23 Costs of productivity loss were operationalized using the human capital method.…”