Treatment pathways, resource use and costs in the management of small cell lung cancer

Abstract

Background-Small cell lung cancer (SCLC) represents about 20% of primary lung tumours and the costs associated with the management of SCLC can be significant. The main objective of this study was to obtain information on current patterns of care and associated resource use and costs for patients with SCLC from initial diagnosis and treatment phase, throughout disease progression and terminal care. Methods-A 4 year retrospective patient chart analysis (1994-7) was conducted on a consecutive series of 109 patients diagnosed with SCLC in two Newcastle hospitals. For this consecutive series of patients all details about care received including tests and procedures, treatment, and medication from diagnosis till death were recorded. Pathways of care and forms were designed to enable resource use to be captured for diVerent disease phases. Unit costs were determined from a variety of sources including the Newcastle Hospitals NHS Trust Finance Department and the British National Formulary. Results-The average total cost per patient calculated for the full cohort of 109 patients was £11 556. Initial treatment was the most resource use intensive constituting 48.2% of the total cost. The major cost element throughout all disease phases was hospitalisation. Twenty eight percent of the total costs of care occur after recurrence of the disease until death, of which 73% are generated by terminal care. Conclusion-The results of this retrospective medical chart analysis show that the costs of care of SCLC are considerable, although the variability between patients in terms of the type and quantity of resource use is very high. Analyses such as this provide a useful insight into resources used in actual clinical practice. (Thorax 2001;56:785-790)

Economics of the clinical management of lung cancer in France: an analysis using a Markov model

“…Moreover, our economic assessment only covered the 18-month period following diagnosis. This is longer than in most studies, which generally focused on initial management costs or the first year after diagnosis, a period that generates between 85 and 97% of total costs (Evans et al, 1995;Oliver et al, 2001). The risk is that major costs are associated with a few surviving patients who receive lengthy palliative care.…”

“…Being centred on the economic consequences of patient management choices, the cost of diagnosis (which is not influenced by treatment choices) was not taken into account. In previous studies (Evans et al, 1995;Oliver et al, 2001), these costs represented between 5 and 10% of Economics of lung cancer management C Chouaïd et al the total management costs. Moreover, our economic assessment only covered the 18-month period following diagnosis.…”

“…In contrast, prophylactic cerebral irradiation was used far less often in our population (33% of localised forms and 0% of diffuse forms, compared to, respectively, 70 and 30% in the Canadian model). An English team recently published the most thorough work to date (Oliver et al, 2001), consisting of a purely descriptive study limited to two hospitals. It did not distinguish diffuse and localised forms, and analysed 109 consecutive patients diagnosed with SCLC between 1994 and 1997 (91.7 and 17.4% of patients, respectively, received first-and second-line treatment).…”

Differences in Practice Patterns and Costs between Small Cell and Non-Small Cell Lung Cancer Patients in Japan

“…LC has been attracting attention both clinically and economically, as new chemotherapeutic agents and diagnostic imaging techniques continue to be developed (Dooms et al 2006;Pimentel et al 2006;Maniadakis et al 2007;Ng et al 2007;Spiro et al 2008). These advances in medical care have benefited LC patients (Oliver et al 2001;Conron et al 2007;Ostgathe et al 2008).…”

“…Although many LC studies have noted a difference in practice between patients with SCLC and those with NSCLC (Oliver et al 2001;Dooms et al 2006;Pimentel et al 2006;Maniadakis et al 2007;Ng et al 2007;Ostgathe et al 2008), the study population were often limited to either small cell LC (SCLC) patients or non-small cell LC (NSCLC) patients. For effective management of health policy for the entire LC population, it is necessary to understand the effect of LC-related variables and prioritize these variables.…”