Quality-adjusted life years in cancer: pros, cons, and alternatives

Woodward, Rebecca; Menzin, Joseph; Neumann, Peter J.

doi:10.1111/ecc.12006

Cited by 9 publications

(11 citation statements)

References 58 publications

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“…92,93 Nevertheless, their use in guiding health care decisions around the world is prevalent. 94 Recently, a cost-effectiveness analysis of the Assessment of Surgical Staging versus Endoscopic Ultrasound in Lung Cancer: a randomized clinical trial (the ASTER Study) from 3 European countries was published by Rintoul and colleagues. 95 In all 3 countries, the use of EBUS/EUS staging had lower mean cost and greater mean QALYs.…”

Section: Cost Analysis Of Ebus-tbnamentioning

confidence: 99%

“…The use of QALYs or other similar measures to establish a threshold for the type of health care that is either cost effective or recommended is now forbidden in the United States under the Patient Protection and Affordable Care Act . Nevertheless, their use in guiding health care decisions around the world is prevalent . Recently, a cost‐effectiveness analysis of the Assessment of Surgical Staging versus Endoscopic Ultrasound in Lung Cancer: a randomized clinical trial (the ASTER Study) from 3 European countries was published by Rintoul and colleagues .…”

Section: Introductionmentioning

confidence: 99%

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Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA): An overview and update for the cytopathologist

VanderLaan

Wang

Majid

et al. 2014

Cancer Cytopathology

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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive technique for evaluating the mediastinum and staging patients with lung cancer. In the hands of an experienced operator, the procedure is safe and provides excellent sensitivity, specificity, and predictive diagnostic values. In conjunction with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), a nearly complete mediastinal evaluation can be performed in a minimally invasive fashion. This strategy results in improved lymph node staging, markedly reduced need for mediastinoscopy, and fewer futile thoracotomies compared with a traditional surgical staging procedure. The procedure is cost effective and provides excellent cytologic specimens that have proven well suited for ancillary testing, such as immunohistochemistry and tumor genotyping. EBUS-TBNA, initially used as a tool to sample the lymph nodes adjacent to the airway walls, has now become instrumental in sampling lesions in the mediastinum, hilum, and lung parenchyma, where previously more than 1 procedure would have been necessary. Looking forward, expanded use of this procedure is likely to revolutionize the access to cytology-proven staging and restaging of lung cancer and other thoracic malignancies in a

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Section: Cost Analysis Of Ebus-tbnamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA): An overview and update for the cytopathologist

VanderLaan

Wang

Majid

et al. 2014

Cancer Cytopathology

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“…The use of costs per QALY's is vital in value‐based decision making (Woodward et al . ). Using real‐world data in cost‐effectiveness models can result in better evidence regarding effectiveness, quality of life and costs for Dutch policy makers by addressing uncertainty in outcomes arising from the gap between clinical trials and everyday practice.…”

Section: Discussionmentioning

confidence: 97%

Real-world resource use and costs of adjuvant treatment for stage III colon cancer

Gils

Groot

Tan

et al. 2013

Eur J Cancer Care (Engl)

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Since the generalisability of trial-based economic evaluations may be limited, there is an increasing focus on real-world cost-effectiveness. Real-world studies involve evaluating the effects and costs of treatments in daily clinical practice. This study reports on the real-world resource use and costs of adjuvant treatments of stage III colon cancer in a population-based observational study. Analyses were based on a detailed retrospective medical chart review which was conducted for 206 patients with colon cancer treated in 2005 and 2006 in the Netherlands. Mean total costs per patient were €9681 for 5-FU/LV, €9736 for capecitabine, €32,793 for FOLFOX and €18,361 for CAPOX. Drug costs and the costs related to hospitalisations for chemotherapy administration were the main cost drivers. We identified a potential for substantial cost-savings when the 48 h administration of 5FU/LV in the FOLFOX regimen were to take place in an outpatient setting or be replaced by oral capecitabine as in the CAPOX regimen. This analysis based on detailed real-life data clearly indicates that clinical choices made in oncology based on efficacy of therapy have economic consequences. Considering today's reality of finite healthcare resources, these economic consequences deserve a formal role in clinical decision making, for instance in guideline development.

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“…Frameworks that use QALYs are limited by their reliance on the assumption of a universal weighting for each outcome dimension or cost metric. 10,11 An effective value framework must be accessible to various stakeholders including patients, providers, payers, employers, administrators, and policy makers. Each stakeholder has a different set of priorities and perspectives, which naturally place different weights on each metric.…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, cost metrics have relied on surrogate measurements such as procedure charges and reimbursements, which do not reflect the true underlying cost to the provider to deliver care. 9–11 To generate a more accurate assessment of the actual consumption of resources throughout a full treatment cycle, the concept of time-driven activity-based costing (TDABC) has been successfully applied in healthcare. 12–17 …”

Section: Introductionmentioning

confidence: 99%

Communicating Value in Health Care Using Radar Charts: A Case Study of Prostate Cancer

Thaker

Ali

Porter

et al. 2016

JOP

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PURPOSE The transformation from volume to value will require communication of outcomes and costs of therapies. However, outcomes are usually non-standardized, and cost of therapy differs amongst stakeholders. We develop a standardized value framework using radar charts to visualize and communicate a wide range of patient outcomes and cost for three forms of prostate cancer treatment. MATERIALS AND METHODS We retrospectively reviewed data from men with low-risk prostate cancer treated with brachytherapy (LDR-BT), proton therapy (PBT), or robotic-assisted prostatectomy (RARP). Patient-reported outcomes comprised the EPIC-50 domains for sexual function, urinary incontinence/bother, bowel bother, and vitality 12 months after treatment. Costs were measured by time-driven activity-based costing for the first 12 months of the care cycle. Outcome and cost data were plotted on a single radar chart for each treatment modality. RESULTS Outcome and cost data from patients treated with RARP (381 patients), PBT (165) and LDR-BT (238) were incorporated into the radar chart. LDR-BT seemed to deliver the highest overall value of the three treatment modalities; however, incorporation of patient preferences regarding outcomes may allow other modalities to be considered a high-value treatment option. CONCLUSIONS Standardization and visualization of outcome and cost metrics may allow more comprehensive and collaborative discussions about the value of healthcare services. Communicating the value framework using radar charts may be an effective method to present total value and the value of all outcomes and costs in a manner that is accessible to all stakeholders. Variations in plotting of costs and outcomes will require future focus-group initiatives.

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Quality-adjusted life years in cancer: pros, cons, and alternatives

Cited by 9 publications

References 58 publications

Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA): An overview and update for the cytopathologist

Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA): An overview and update for the cytopathologist

Real-world resource use and costs of adjuvant treatment for stage III colon cancer

Communicating Value in Health Care Using Radar Charts: A Case Study of Prostate Cancer

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