Estimating the direct costs of bowel cancer services provided by the National Health Service in England

Bending, M.W.; Trueman, Paul; Lowson, Karin; Pilgrim, Hazel; Tappenden, Paul; Chilcott, Jim; Tappenden, Janine

doi:10.1017/s0266462310001078

Cited by 16 publications

(13 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Public patients with non‐threatening symptoms are therefore at higher risk of emergency admission than private patients, who can opt to bypass queues for secondary care . However, although emergency admission would be less frequent if doctors referred earlier and more often investigation of suspected colorectal cancer is expensive and there must be a balance between over‐and under‐referral. The consequence of more open access may be fewer emergency admissions but higher costs for investigation of the many symptomatic patients who turn out not to have cancer …”

Section: Discussionmentioning

confidence: 99%

Causes and outcomes of emergency presentation of rectal cancer

Comber

Sharp

Cancela

et al. 2016

Intl Journal of Cancer

View full text Add to dashboard Cite

Emergency presentation of rectal cancer carries a relatively poor prognosis, but the roles and interactions of causative factors remain unclear. We describe an innovative statistical approach which distinguishes between direct and indirect effects of a number of contextual, patient and tumour factors on emergency presentation and outcome of rectal cancer. All patients diagnosed with rectal cancer in Ireland 2004-2008 were included. Registry information, linked to hospital discharge data, provided data on patient demographics, comorbidity and health insurance; population density and deprivation of area of residence; tumour type, site, grade and stage; treatment type and optimality; and emergency presentation and hospital caseload. Data were modelled using a structural equation model with a discrete-time survival outcome, allowing us to estimate direct and mediated effects of the above factors on hazard, and their inter-relationships. Two thousand seven hundred and fifty patients were included in the analysis. Around 12% had emergency presentations, which increased hazard by 80%. Affluence, private patient status and being married reduced hazard indirectly by reducing emergency presentation. Older patients had more emergency presentations, while married patients, private patients or those living in less deprived areas had fewer than expected. Patients presenting as an emergency were less likely to receive optimal treatment or to have this in a high caseload hospital. Apart from stage, emergency admission was the strongest determinant of poor survival. The factors contributing to emergency admission in this study are similar to those associated with diagnostic delay. The socio-economic gradient found suggests that patient education and earlier access to endoscopic investigation for public patients could reduce emergency presentation.

show abstract

Section: Discussionmentioning

confidence: 99%

Causes and outcomes of emergency presentation of rectal cancer

Comber

Sharp

Cancela

et al. 2016

Intl Journal of Cancer

View full text Add to dashboard Cite

show abstract

“…CRC is thought to constitute more than 10% of this burden in the USA [6]. Emerging evidence from other settings also suggests the health services cost associated with CRC are significant [7-11]. As more people require treatment and treatments become more expensive, these costs are likely to increase.…”

Section: Introductionmentioning

confidence: 99%

Inter-relationships between the economic and emotional consequences of colorectal cancer for patients and their families: a qualitative study

et al. 2012

View full text Add to dashboard Cite

BackgroundWhile the evidence-base concerning the economic impact of cancer for patients and their families/carers has grown in recent years, there is little known about how emotional responses to cancer influence this economic impact. We investigated the economic costs of cancer in the context of patients’ emotions and how these both shaped the patient and family burden.MethodsHealth professionals from six hospitals invited patients diagnosed with colorectal cancer (ICD10 C18-C20) within the previous year to take part in the study. Semi-structured face-to-face interviews were conducted with patients and, where available, a family member. Interviews covered medical and non-medical costs incurred as a result of cancer and the impact of these on the lives of the patient and their family. Interviews were audio-recorded. Recordings were transcribed verbatim and these data were analysed qualitatively using thematic content analysis.ResultsTwenty-two patients with colorectal cancer (17 colon and 5 rectal; 14 women and 8 men) were interviewed; 6 were accompanied by a family member. Important cancer-related financial outlays included: travel and parking associated with hospital appointments; costs of procedures; increased household bills; and new clothing. Cancer impacted on employed individuals’ ability to work and depressed their income. The opportunity cost of informal care for carers/family members, especially immediately post-diagnosis, was a strong theme. All patients spoke of the emotional burden of colorectal cancer and described how this burden could lead to further costs for themselves and their families by limiting work and hindering their ability to efficiently manage their expenses. Some patients also spoke of how economic and emotional burdens could interact with each other. Support from employers, family/carers and the state/health services and patients’ own attitudes influenced this inter-relationship.ConclusionsThe economic impact of colorectal cancer on patients and their families is complex. This study suggests that the economic costs and the emotional impact of cancer are often related and can exacerbate each other, but that various factors can meditate this inter-relationship.

show abstract

“…Bending et al, [19] used Monte Carlo sampling techniques to estimate the direct cost of bowel cancer services.…”

Section: Exploration Of a Sample Of Papersmentioning

confidence: 99%

Clinical pathway modelling: a literature review

2019

View full text Add to dashboard Cite

Hospital information systems are increasingly used as part of decision support tools for planning at strategic, tactical and operational decision levels. Clinical pathways are an effective and efficient approach in standardising the progression of treatment, to support patient care and facilitate clinical decision making. This literature review proposes a taxonomy of problems related to clinical pathways and explores the intersection between Information Systems (IS), Operational Research (OR) and industrial engineering. A structured search identified 175 papers included in the taxonomy and analysed in this review. The findings suggest that future work should consider industrial engineering integrated with OR techniques, with an aim to improving the handling of multiple scopes within one model, while encouraging interaction between the disjoint care levels and with a more direct focus on patient outcomes. Achieving this would continue to bridge the gap between OR, IS and industrial engineering, for clinical pathways to aid decision support.

show abstract

Estimating the direct costs of bowel cancer services provided by the National Health Service in England

Cited by 16 publications

References 20 publications

Causes and outcomes of emergency presentation of rectal cancer

Causes and outcomes of emergency presentation of rectal cancer

Inter-relationships between the economic and emotional consequences of colorectal cancer for patients and their families: a qualitative study

Clinical pathway modelling: a literature review

Contact Info

Product

Resources

About