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Economic studies of health technology changes in prostate cancer care
Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: New health technologies are one of the major drivers of increasing health care costs, although not all technologies have been shown to be effective. Initiation of activities for ensuring an appropriate diffusion of new health technologies is therefore an important task for a society. To ensure a choice of relevant policy actions, it is necessary to have knowledge about what factors affect the rate and extent of diffusion and what consequences can be expected from adopting a new health technology.

Aim: The aim of this thesis is to estimate economic consequences and cost-effectiveness of health technology changes and to explore factors affecting the diffusion of health technologies. To elucidate these issues, prostate cancer was used as the subject of study.

Material and Methods: The diffusion of six selected technologies for prostate cancer care was analysed and the economic consequences of these technological changes estimated. Data describing the diffusion and costs were obtained from relevant databases. Economic consequences of technological changes in prostate cancer care were also estimated with a cohort approach using 204 men with a diagnosis of prostate cancer who died in 1997-98. Data on health service utilization were extracted from clinical records and the results were compared with those of corresponding cohorts of men who died in 1984-85 or in 1992-93. The cost-effectiveness and expected economic consequences of introduction of prostate cancer screening in Sweden were estimated based on randomized studies in the city of Norrköping (n=9,171) and in the city of Gothenburg (n=20,000). The potential value of a technological change in the treatment of prostate cancer pain was estimated based on data from 1,156 men with a diagnosis of prostate cancer.

Results: The utilization of all selected technologies has increased over time with the exception of orchiectomy, which shows a decreasing use. The total cost of these technologies has increased from 200 MSEK in 1991 to 600 MSEK in 2002. Classification of radical prostatectomy revealed a profile associated with a slow/limited diffusion, while classification of PSA tests revealed a profile associated with a rapid/extensive diffusion. The total health care costs for prostate cancer in Sweden have increased from 610 MSEK in 1984-85 to 970 MSEK in 1997-98, but the average cost per patient has been nearly stable over time. The incremental cost per extra detected localized cancer in a prostate cancer screening programme was estimated at 168,000 SEK and 98,000 SEK, respectively, and per curative aimed treated cancer at 356,000 SEK and 236,000 SEK. Introducing a screening programme for prostate cancer in Sweden would yield 244 MSEK and 92 MSEK, respectively, in additional costs per year for screening and treatment compared to a non-screening strategy. An optimal treatment that would reduce pain to zero during the whole episode of disease would add on average 0.85 quality-adjusted life-years for every man with prostate cancer. A rough estimate for Sweden is a total expected loss of 4,421 QALYs per year at a monetary value of 840 MSEK.

Conclusions: Many technological changes occur in prostate cancer care and result in cost increases with minor or uncertain health improvements. A number of factors in addition to cost-effectiveness of the technology influence the diffusion. To ensure an appropriate diffusion of health technologies in society, one necessary condition is a system for early identification and assessment of cost-effectiveness and economic consequences. Another is an appropriate use of decision models populated with data from early clinical trials, epidemiology and costs. The combination of assessment of the costs and effects and identification of the diffusion profile of the technology may facilitate the design of relevant policy actions to promote an effective utilization of health technologies.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2005. , 110 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 889
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-29365Local ID: 14689ISBN: 91-7373-868-9 (print)OAI: oai:DiVA.org:liu-29365DiVA: diva2:250177
Public defence
2005-04-29, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-10-02Bibliographically approved
List of papers
1. Diffusion and Economic Consequences of Health Technologies in Prostate Cancer Care in Sweden, 1991-2002
Open this publication in new window or tab >>Diffusion and Economic Consequences of Health Technologies in Prostate Cancer Care in Sweden, 1991-2002
2006 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 49, no 6, 1028-1034 p.Article in journal (Refereed) Published
Abstract [en]

   Objective

To describe the diffusion of six main health technologies used for management of prostate cancer, to estimate the economic consequences of technological changes, and to explore factors behind the diffusion.

Methods

Data describing the diffusion 1991–2002 were obtained from population-based databases. Costs were obtained from Linköping University Hospital and Apoteket AB. Factors affecting the diffusion of the technologies were explored.

Results

Utilization of technologies with a curative and/or palliative aim has increased over time, except for surgical castration. PSA-tests are used increasingly. The total cost of the study technologies has increased from 20 million euros in 1991 to 65 million euros in 2002. Classification of radical prostatectomy revealed a profile associated with a slow/limited diffusion, while classification of PSA-tests revealed a profile associated with a rapid/extensive diffusion.

Conclusions

Several technological changes in the management of prostate cancer have occurred without proven benefits and have contributed to increased costs. There are other factors, besides scientific evidence, that have an impact on the diffusion. Consequently, activities aimed at facilitating an appropriate diffusion of new technologies are needed. The analytical framework used here may be helpful in identifying technologies that are likely to experience inappropriate diffusion and therefore need particular attention.

National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-36907 (URN)10.1016/j.eururo.2005.12.018 (DOI)33009 (Local ID)33009 (Archive number)33009 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2012-10-02Bibliographically approved
2. Technological changes in the management of prostate cancer result in increased healthcare costs: a retrospective study in a defined Swedish population
Open this publication in new window or tab >>Technological changes in the management of prostate cancer result in increased healthcare costs: a retrospective study in a defined Swedish population
Show others...
2003 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 37, no 3, 226-231 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

In two previous studies we calculated direct costs for men with prostate cancer who died in 1984-85 and 1992-93, respectively. We have now performed a third cost analysis to enable a longitudinal cost comparison. The aim was to calculate direct costs for the management of prostate cancer, describe the economic consequences of technological changes over time and estimate total direct costs for prostate cancer in Sweden.

MATERIAL AND METHODS:

A total of 204 men in a defined population with a diagnosis of prostate cancer and who died in 1997-98 were included. Data on utilization of health services were extracted from clinical records from time of diagnosis to death from a university hospital and from one county hospital in the county of Ostergötland.

RESULTS:

The average direct cost per patient has been nearly stable over time (1984-85: 143 000 SEK; 1992-93: 150 000 SEK; 1997-98: 146 000 SEK). The share of costs for drugs increased from 7% in 1992-93 to 17% in 1997-98. The total direct costs for prostate cancer in Sweden have increased over time (1994-85: 610 MSEK; 1992-93: 860 MSEK; 1997-98: 970 MSEK).

CONCLUSIONS:

Two-thirds of the total cost is incurred by inpatient care. The share of the total costs for drugs is increasing due to increased use of gonadotrophin-releasing hormone analogues. Small changes in average direct costs per patient despite greater use of technology are explained by the fact that more prostate cancers are detected at the early stages.

Keyword
Costs, Prostate cancer, Technological changes
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-46551 (URN)10.1080/00365590310008109 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2012-10-02Bibliographically approved
3. Costs and effects of prostate cancer screening in Sweden: a 15-year follow-up of a randomized trial
Open this publication in new window or tab >>Costs and effects of prostate cancer screening in Sweden: a 15-year follow-up of a randomized trial
2004 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 38, no 4, 291-298 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To estimate the lifetime cost per detected potentially curable cancer and the economic impact on healthcare of repeated screening for prostate cancer in Sweden in a cohort of men aged 50-69 years.

MATERIAL AND METHODS:

All 9171 men in a geographically defined population were included: 1492 were randomized to screening in four rounds every third year and 7679 constituted a control group. Digital rectal examination and prostate-specific antigen screening in different combinations were used as diagnostic measures. Costs associated with administration of the screening programme, loss of patient time, diagnostic measures and management strategies were included. A decision model was developed to calculate the total cost of the programme.

RESULTS:

The incremental cost per extra detected localized cancer was 168,000 SEK and per potentially curable cancer 356,000 SEK. Introducing this screening programme for prostate cancer in Sweden would incur 244 million SEK annually in additional costs for screening and treatment compared to a non-screening strategy.

CONCLUSION:

There is still no scientific evidence that patients will benefit from screening programmes. Prostate cancer screening would probably be perceived as cost-effective if potentially curable patients gained on average at least 1 year of survival.

Keyword
Costs, Prostate cancer, Screening
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-45606 (URN)10.1080/00365590410028890 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2012-10-02Bibliographically approved
4. Costs and effect of biennial prostate cancer screening in Sweden: results from a randomized trial in a defined population
Open this publication in new window or tab >>Costs and effect of biennial prostate cancer screening in Sweden: results from a randomized trial in a defined population
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: The aim was to estimate the lifetime cost in relation to the extra number of detected localized and potentially curable cancers, and to estimate the economic impact on health care of repeated screening for prostate cancer in Sweden in a cohort of men aged 50-64 years.

Material and Methods: From the total male population in the city of Gothenburg born between 1930-1944 (n=32,298), 10,000 men were randornized to prostate cancer screening beginning in January 1995, and 10,000 men were randomized to serve as a control group. PSA tests were offered every 2nd year until the age of 70. All health care costs for administration of the screening programme, screening tests, diagnostic procedures, and treatments were included. Data on detected cancers were collected from the prospective programme and from patient records. A Markov model was developed to calculate the cost-effectiveness and the total extra cost of the screening programme.

Results: For the period from the start of the screening programme until death, the estimates were 17.7 extra localized cancers per 1,000 men and 7.3 extra cases of curative aimed treatments per 1,000 men. The incremental cost per extra detected localized cancer was calculated at 98,000 SEK, and per cancer with curative aimed treatment the figure was 236,000 SEK. Introducing this screening programme for prostate cancer in Sweden would yield 92 million SEK annually in additional costs for screening and management compared to a non-screening strategy.

Conclusion: Introduction of prostate cancer screening with PSA would increase the total economic burden of prostate cancer for society by approximately 30 percent. Due to the lack of scientific data concerning possible survival benefits from prostate cancer screening, we must wait several years before the true cost-effectiveness of the programme can be calculated.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84229 (URN)
Available from: 2012-10-02 Created: 2012-10-02 Last updated: 2012-10-02Bibliographically approved
5. The estimated economic value of the welfare loss due to prostate cancer pain in a defined population
Open this publication in new window or tab >>The estimated economic value of the welfare loss due to prostate cancer pain in a defined population
2004 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 43, no 3, 290-296 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study reported here was to estimate the economic value of the welfare loss due to prostate cancer pain by estimating the extent to which pain affects health-related quality of life among patients with prostate cancer. The material consisted of a point estimate of health status among men with prostate cancer in a well-defined population of 200 000 males. Clinical data concerning the disease at diagnosis (extracted from patients’ records and the Regional Prostate Cancer Registry), and health utility ratings (using EuroQol) were obtained from 1 156 males with prostate cancer. A descriptive model showed that optimal treatment that would reduce pain to zero during the whole episode of disease would add on average 0.85 quality-adjusted life years (QALY) to every man with prostate cancer. Based on an estimate of the willingness to pay for a QALY the economic value of this welfare loss due to prostate cancer pain is in the magnitude of €86 600 000 per year (€19 800 000 per million men in Sweden).

National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-23961 (URN)10.1080/02841860410028411 (DOI)3511 (Local ID)3511 (Archive number)3511 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-02Bibliographically approved

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