Health Resource and Cost Savings Achieved in a Multidisciplinary Lung Cancer Clinic
Abstract
:1. Introduction
2. Patients and Methods
2.1. Context—Launching a Lung Cancer MDC
2.2. Evaluation of the LC MDC
2.3. Economic Analysis
2.4. Invasive Mediastinal Staging by EBUS Economic Analysis
3. Results
3.1. Clinic Characteristics
3.2. Impact on Number of Oncology Visits
3.3. Impact on Biopsies, Staging Investigations, and Treatment
3.4. Economic Analysis
3.5. Threshold Sensitivity Analysis—Invasive Mediastinal Staging by EBUS-TBNA
3.6. Secondary Unanticipated Benefits
3.7. Balancing Measures
4. Discussion
Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Traditional Model (n = 78) | MDC (n = 350) |
---|---|---|
Patient Characteristics | ||
Mean Age in Years (± SD) | 70.0 (9.7) | 71.7 (9.1) |
Pathologic LC Diagnosis | ||
NSCLC | 69 (88.5) | 260 (74.3) |
SCLC | 9 (11.5) | 45 (12.9) |
Presumed LC | N/A | 45 (12.9) |
Clinical LC Stage | ||
1 | 24 (30.8) | 109 (31.1) |
2 | 6 (7.7) | 26 (7.4) |
3 | 14 (18.0) | 69 (19.7) |
4 | 29 (37.3) | 143 (40.9) |
Undetermined | 5 (6.4) | 3 (0.9) |
Mean Return Distance to KHSC (km) | N/A | 102.0 |
Diagnosis of Patients with Non-LC Pathology that Received Consultation in MDC (n = 24) | ||
Cancer Type | ||
Breast | N/A | 8 |
Mesothelioma | N/A | 4 |
Other Non-LC | N/A | 12 |
Traditional Model | MDC | p Value | |
---|---|---|---|
Mean Oncology Visits per Patient from Diagnosis to Treatment a | |||
All patients | 2.68 | 1.62 | <0.001 |
Stage 1 LC (n = 133) | 2.29 | 1.66 | 0.006 |
Stage 2 LC (n = 32) | 2.33 | 2.13 | 0.58 |
Stage 3 LC (n = 83) | 3.43 | 2.03 | 0.004 |
Stage 4 LC (n = 172) | 2.55 | 1.29 | <0.001 |
Health Resource Utilization from Diagnosis to Treatment | |||
Mean Biopsies per Patient | 1.32 | 1.17 | 0.18 |
Mean Staging Imaging per Patient | 2.24 | 2.02 | 0.20 |
Invasive Mediastinal Staging by EBUS-TBNA for patients with stage 2 or 3 LC % (n) | 15.0% (3/20) | 60.0% (57/95) | <0.001 |
Treatments Received by LC Patients a | |||
Stage 1 LC curative TS %(n) | 20.8% (5/24) | 13.7% (15/109) | 0.44 |
Stage 1 LC curative RT %(n) | 87.5% (21/24) | 77.1% (84/109) | 0.20 |
Stage 2 LC curative TS %(n) | 33.3% (2/6) | 23.1% (6/26) | 0.67 |
Stage 2 LC curative RT %(n) | 83.3% (5/6) | 65.4% (17/26) | 0.37 |
Stage 3 ST + RT %(n) | 57.1% (8/14) | 53.6% (37/69) | 0.82 |
Stage 4 LC receiving ST %(n) | 37.9% (11/29) | 39.9% (57/143) | 0.85 |
Variable | Base Case |
---|---|
Patient Visits Saved [n = 350] | 371 |
Caregiver Visits Saved [1.25 caregivers/patient visit saved] | 464 |
Patients <65 years of age | 23% |
Parking Cost | $6.00/visit |
Clinic Visit Duration | 1.26 h |
Time Forgone (return travel, parking, finding clinic) | 1.27 h |
Caregivers Incurring Productivity Loss | 50% |
Out-of-Pocket Cost Savings | |
Parking Cost ($6/visit) | $2226 |
Return Travel Cost ($59.14/visit) | $21,941 |
Out-of-Pocket Cost Savings per Patient | $69 |
Total Out-of-Pocket Cost Savings | $24,167 |
Productivity Loss Savings | |
Patient Opportunity Cost ($29.55/hour) | $6379 |
Caregiver Opportunity Cost ($29.55/hour) | $17,335 |
Total Productivity Loss Savings | $23,714 |
Total Patient Out-of-Pocket Expenses + Productivity Loss Savings | $47,882 |
Clinic Visit Cost | |
Cost for Time Spent Booking Appointments ($1.37/visit) | $508 |
Total Personnel Cost Savings | $508 |
Total Savings | $48,389 |
Unit Variables | ||
---|---|---|
EBUS-TBNA Cost | $1577/procedure | |
Caregiver Visits [1 caregivers/EBUS-TBNA Procedure] | 3 | |
Patients <65 years of age | 33% | |
Parking Cost | $9.00/visit | |
Time Forgone (return travel, parking, procedure, recovery) | 7.5 h | |
Caregivers Incurring Productivity Loss | 50% | |
Quality-Adjusted Life Years/EBUS-TBNA | 0.071 | |
Threshold Analysis | Traditional Model | MDC |
# EBUS-TBNA Procedures | 3 | 57 |
Quality-Adjusted Life Years | 0.21 | 4.05 |
Procedural Costs | ||
EBUS-TBNA | $4731 | $89,889 |
Out-of-Pocket Costs | ||
Parking Cost ($9/visit) | $14 | $257 |
Return Travel Cost ($59.14/visit) | $177 | $3371 |
Total Out-of-Pocket Costs | $192 | $3627 |
Productivity Loss Costs | ||
Patient Opportunity Cost ($29.55/hour) | $221 | $4207 |
Caregiver Opportunity Cost ($29.55/hour) | $333 | $6316 |
Total Productivity Loss Savings | $554 | $10,523 |
Total EBUS-TBNA Cost | $5476 | $104,039 |
Cost per QALY | $25,708 |
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Stone, C.J.L.; Johnson, A.P.; Robinson, D.; Katyukha, A.; Egan, R.; Linton, S.; Parker, C.; Robinson, A.; Digby, G.C. Health Resource and Cost Savings Achieved in a Multidisciplinary Lung Cancer Clinic. Curr. Oncol. 2021, 28, 1681-1695. https://doi.org/10.3390/curroncol28030157
Stone CJL, Johnson AP, Robinson D, Katyukha A, Egan R, Linton S, Parker C, Robinson A, Digby GC. Health Resource and Cost Savings Achieved in a Multidisciplinary Lung Cancer Clinic. Current Oncology. 2021; 28(3):1681-1695. https://doi.org/10.3390/curroncol28030157
Chicago/Turabian StyleStone, Christopher J. L., Ana P. Johnson, Danielle Robinson, Andriy Katyukha, Rylan Egan, Sophia Linton, Christopher Parker, Andrew Robinson, and Geneviève C. Digby. 2021. "Health Resource and Cost Savings Achieved in a Multidisciplinary Lung Cancer Clinic" Current Oncology 28, no. 3: 1681-1695. https://doi.org/10.3390/curroncol28030157
APA StyleStone, C. J. L., Johnson, A. P., Robinson, D., Katyukha, A., Egan, R., Linton, S., Parker, C., Robinson, A., & Digby, G. C. (2021). Health Resource and Cost Savings Achieved in a Multidisciplinary Lung Cancer Clinic. Current Oncology, 28(3), 1681-1695. https://doi.org/10.3390/curroncol28030157