PET-CT in oesophageal cancer management: a cost effectiveness analysis (CEA) / Nor Aniza Azmi

This study involved assessment of clinician's views on practicality, clinical efficacy and cost -effectiveness of PET-CT in oesophageal cancer management and decision making model-based economic evaluation to investigate the relative cost-effectiveness of PET/CT in oesophageal cancer management staging based on review of publications and retrospective data. Total of 73 clinicians included in the survey. Retrospective analysis of patient data from 2001-2008 taken from Royal Liverpool &Broadgreen University Hospital Trust (RLBUHT) medical records and North West Cancer Intelligence Services (NWCIS) database for the same period. A decision tree was developed using TREEAGE software. The relevant data on accuracy, sensitivity and specificity of each diagnostic test were linked in the model, to cost and the primary outcome measure, cost per quality-adjusted life-year (QALY). The model estimated the mean cost associated with each diagnostic procedure and assumed that patients entering the model were aged 35-75 years. The results of the cost-effectiveness analysis are presented in terms of the incremental cost-effectiveness ratios (ICERs).PET compared with conventional work-up results for ICER for the strategy estimated at £28,460 per QALY; PET/CT compared with PET for ICER was £ 32,590 per QALY; and the ICER for PET/CT combined with conventional workup versus PET/CT was £ 44,118. The package become more expensive with each additional diagnostic test added to PET and the more effective in terms of QALYs gained. The conventional work-up is the preferred options as probabilistic sensitivity analysis shows at a willingnessto- pay (WTP) threshold of £ 20,000 per QALY. Result of the current analysis suggests that the use of PET/CT in the diagnosis of oesophageal cancer is unlikely to be cost-effective given the current WTP thresholds that are accepted in the United Kingdom by decision-making bodies such as the National Institute for Health and Clinical Excellence and National Health Services. Based on the current model and given the limitations that are apparent in terms of limited availability of data, the modelling suggests that the most cost-effective diagnostic strategy are the conventional work-up given current data. Future studies need to secure robust cost data that can be verified from more than one source for the diagnostic tests involved. It is also crucial to have reliable and verifiable data on quality of life associated with this clinical condition

PET-CT in esophageal cancer management: a cost effectiveness analysis study

The present investigation dealt with the assessment of clinicians perceived views on the impact of PET-CT in esophageal cancer management from practicality, clinical efficacy and cost –effectiveness point of views. Reviews on publication and retrospective data to develop and carry out a decision-making model-based economic evaluation to investigate the relative cost-effectiveness of PET/CT in esophageal cancer management staging compared with conventional pathway. Clinicians identified from patient medical records were included in the survey. Retrospective analysis of patient data from 2001-2008 was taken from esophageal cancer patient medical records and North West Cancer Intelligence Services (NWCIS) database. A decision tree was developed using TREEAGE software. The results of the cost-effectiveness analysis were presented in terms of the incremental cost-effectiveness ratios (I-CERs). PET compared with conventional work-up results for ICER for the strategy estimated at £28,460 per QALY; PET/CT compared with PET for ICER was £ 32,590 per QALY; and the ICER for PET/CT combined with conventional work-up versus PET/CT was £ 44,118. The package became more expensive with each additional diagnostic test added to PET and more effective in terms of QALYs gained. The conventional work-up was the preferred options as probabilistic sensitivity analysis showed at a willingness-to-pay threshold of £ 20,000 per QALY. Result of the current analysis suggested that the use of PET/CT in the diagnosis of esophageal cancer was unlikely to be cost-effective given the current willingness-to-pay thresholds that were accepted in the United Kingdom by decision-making bodies such as the National Institute for Health and Clinical Excellence

Characterizing employees with primary and secondary caregiving responsibilities: informal care provision in Malaysia

There is a need to determine the extent to which Malaysian employees reconcile both paid employment and informal care provision. We examined data from the Malaysia’s Healthiest Workplace via AIA Vitality Online Survey 2019 (N = 17,286). A multivariate multinomial regression was conducted to examine characteristics for the following groups: primary caregiver of a child or disabled child, primary caregiver of a disabled adult or elderly individual, primary caregiver for both children and elderly, as well as secondary caregivers. Respondent mean age ± SD was 34.76 ± 9.31, with 49.6% (n = 8573), identifying as either a primary or secondary caregiver to at least one child under 18 years, an elderly individual, or both. Males (n = 6957; 40.2%) had higher odds of being primary caregivers to children (OR 2.06; 95% CI 1.85–2.30), elderly (OR 1.24; 95% CI 1.09–1.41) and both children and elderly (OR 1.87; 95% CI 1.57–2.22). However, males were less likely to be secondary caregivers than females (OR 0.61; 95% CI 0.53–0.71). Our results highlight the differences in characteristics of employees engaged in informal care provision, and to a lesser degree, the extent to which mid-life individual employees are sandwiched into caring for children and/or the elderly

How many roads must a Malaysian walk down? Mapping the accessibility of radiotherapy facilities in Malaysia.

BackgroundThe accessibility to radiotherapy facilities may affect the willingness to undergo treatment. We sought to quantify the distance and travel time of Malaysian population to the closest radiotherapy centre and to estimate the megavoltage unit (MV)/million population based on the regions.Materials & methodsData for subdistricts in Malaysia and radiotherapy services were extracted from Department of Statistics Malaysia and Directory of Radiotherapy Centres (DIRAC). Data from DIRAC were validated by direct communication with centres. Locations of radiotherapy centres, distance and travel time to the nearest radiotherapy were estimated using web mapping service, Google Map.ResultsThe average distance and travel time from Malaysian population to the closest radiotherapy centre were 82.5km and 83.4mins, respectively. The average distance and travel were not homogenous; East Malaysia (228.1km, 236.1mins), Central (14.4km, 20.1mins), East Coast (124.2km, 108.8mins), Northern (42.9km, 42.8mins) and Southern (36.0km, 39.8mins). The MV/million population for the country is 2.47, East Malaysia (1.76), Central (4.19), East Coast (0.54), Northern (2.40), Southern (2.36). About 25% of the population needs to travel >100 km to get to the closest radiotherapy facility.ConclusionOn average, Malaysians need to travel far and long to reach radiotherapy facilities. The accessibility to radiotherapy facilities is not equitable. The disparity may be reduced by adding centres in East Malaysia and the East Coast

Economic burden of managing Type 2 diabetes mellitus: Analysis from a Teaching Hospital in Malaysia

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease that consumes a large amount of health-care resources. It is essential to estimate the cost of managing T2DM to the society, especially in developing countries. Economic studies of T2DM as a primary diagnosis would assist efficient health-care resource allocation for disease management. Objective: This study aims to measure the economic burden of T2DM as the primary diagnosis for hospitalization from provider's perspective. Methods: A retrospective prevalence-based costing study was conducted in a teaching hospital. Financial administrative data and inpatient medical records of patients with primary diagnosis (International Classification Disease-10 coding) E11 in the year 2013 were included in costing analysis. Average cost per episode of care and average cost per outpatient visit were calculated using gross direct costing allocation approach. Results: Total admissions for T2DM as primary diagnosis in 2013 were 217 with total outpatient visits of 3214. Average cost per episode of care was RM 901.51 (US$286.20) and the average cost per outpatient visit was RM 641.02 (US$ 203.50) from provider's perspective. The annual economic burden of T2DM for hospitalized patients was RM 195,627.67 (US$62,104) and RM 2,061,520.32 (US$ 654,450) for those being treated in the outpatient setting.Conclusions: Economic burden to provide T2DM care was higher in the outpatient setting due to the higher utilization of the health-care service in this setting. Thus, more focus toward improving T2DM outpatient service could mitigate further increase in health-care cost from this chronic disease