Considerations on cancer-cost discussion: Eurochip-3

Regarding the issue of cancer-cost reduction, good quality data on costs are a prerequisite. That is to say that prior to any considerations on cost reductions, a good picture of all the parameters that generate costs should be available.However, cost analysis is a quite complex task that depends on the degree of the desirable/feasible level of accuracy. That is to say that the more accurate figures one wants to achieve, the more deeper he has to go down the analysis of functions and procedures and the more resources he requires to perform the analysis. There are lots of issues to be discussed regarding the costs of cancer care management. Nonetheless, I identified six major areas which may be considered as cost categories and could be further analyzed. These cost categories are: 

  1. Information collection (e.g. cancer registration)
  2. Prevention (e.g. screening programmes and HPV immunization)
  3. Primary care (follow-up included)
  4. Secondary care (follow-up included)
  5. Palliative care
  6. All other related activities not classified above

 Bellow, I attach two papers concerning the costs of cancer management that may be helpful for the work of Eurochip-3 as references. Also, they may be useful in considering and in devising an economic model for cancer care. To the best of my knowledge, an important and interesting approach to “costing” cancer-care-services is that of BJM Graham of the ISD Cancer Information Group entitled “The Cost of Cancer Care in Scotland-2002” (see the link: http://www.isdscotland.org/isd/servlet/FileBuffer?namedFile=Cancercosts10rtf.pdf&pContentDispositionType=inline). ISD Scotland is an excellent Health Information Service for the Scottish NHS that collects routinely a plethora of data. Due to the nature of the Scottish healthcare system’s structure and on the basis of a rich pool of e-health data, the author was able to estimate a variety of costs concerning the cancer care in his country (a full range of estimations from the total cost of cancer-care to the mean cost estimates of cancer patients’ follow-up appointments). Certainly this approach is not feasible in most other countries but this study could be very useful for discussion. Besides it includes many references. 

Another interesting work, tackling the issue of cancer-care cost-reduction, is that of Professor D. Taylor and S. Carter from the London University School of Pharmacy prepared for “Marie Curie Cancer Care” (NGO). This paper is entitled “Valuing Choice – Dying at Home” and can be found in the link: http://campaign.mariecurie.org.uk/NR/rdonlyres/646C31D0-49C1-42C5-8BFE-D1A8F3F3A499/0/campaign_valuing_choice.pdf. This paper concerns only the care for the terminally ill and the authors argue that, by investing more in high quality palliative care at home services, there will be big savings for the hospital care services. More precisely they argue that, in the medium to long term, every £1 extra investment in “palliative care at home” services will result in a £2 release in the hospital services. This paper has also quite interesting references.

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LAST UPDATED: 19 July 2008

Recent article: Economic evaluation of cancer treatment in the US:

Economic Evaluations of Medical Care Interventions for Cancer Patients: How, Why, and What Does it Mean?“, Ya-Chen Tina Shih and Michael T. Halpern, CA Cancer J Clin 2008; 58:231-244 [free full text], (link, last accessed: July 19, 2008). 

Date entered: 25 June 2008

Evaluation of Trends in the Cost of Initial Cancer Treatment“, Joan L. Warren, K. Robin Yabroff, Angela Meekins, Marie Topor, Elizabeth B. Lamont, Martin L. Brown, J Natl Cancer Inst 2008;100:888-897 [abstract free], (link, last accessed: June 25, 2008) 

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Considerations regarding the proposed keypoint 5 (HPV vaccine)

Keypoint 5 for consideration: “Include HPV vaccination in registration” (see topic).

“Regarding the potential impact of HPV vaccination on cancer incidence and mortality, perhaps one of the important issues to consider is whether the reporting of vaccinated people should be mandatory and should be linked with the cervical screening registers”. 

The following article was published recently (1st Oct. 2007):

A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program.
S Kulasingam, L Connelly, E Conway, JS Hocking, E Myers, DG Regan, D Roder, J Ross, and G Wain, Sex Health. 2007; 4: 165. [MEDLINE Citation]

From the title and the abstract it is obvious that (at least) in Australia there were considerations to add the HPV-vaccine to the national cervical cancer screening program.

In my opinion the HPV-vaccination is a serious subject to discuss since it may have a great economic burden either to the social security systems or to the individual citizens.

Currently, there are many who strongly support the HPV-vaccination and others who examine its cost-effectiveness. However, personally I think that this matter should be considered carefully since “a strategy being cost-effective does not mean that the strategy saves money, and just because a strategy saves money doesn’t mean that it is cost-effective” (American College of Physicians: “Primer on Cost-Effectiveness Analysis”, Effective Clinical Practice, September/October 2000; see link: http://www.acponline.org/journals/ecp/sepoct00/primer.htm).

Nevertheless, I think that the registration of the vaccinated cases is a necessity since it will allow follow-up and population comparisons in the long run.

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Regarding the above views (expressed before the EUROCHIP meeting in Varenna in October 18th, 2007), the following articles quoted:

1. quote: “Long-term follow-up studies are planned through the Nordic cancer registries to assess duration of HPV protection” in Correlating immunity with protection for HPV infection, I Frazer, Int J Infect Dis. 2007; 11 Suppl 2: S10. [MEDLINE Citation]

2. quote: “Nordic cancer registries are providing ongoing long-term pharmacovigilance” in Overview of the clinical development and results of a quadrivalent HPV (types 6, 11, 16, 18) vaccine“, LL Villa, Int J Infect Dis. 2007; 11 Suppl 2: S17. [MEDLINE Citation]

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EUROCHIP meeting in Varenna: Key points for debate

Key points to consider and comment:

  • 1. financing the new EU Health Strategy
  • 2. development of Public Health Services
  • 3. (how to) balance the inequalities that exist among countries
  • 4. mandate the national cancer control strategies and the cancer registration
  • 5. include HPV vaccination in registration
  • 6. new version of the “Survey of Cancer Registries in the European Union”
  • 7. development of guidelines for a “Cancer-Patient Health Record”.
  • 8. Mass Media and Cancer
  • 9. EU Cancer Research Database

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Considerations on the new EU Health Strategy on Cancer

Follow the link to read the article: Points to consider .

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