Understanding the costs of cancer care before and after diagnosis for the 21 most common cancers in Ontario: a population-based descriptive study

Background: The first year after cancer diagnosis is a period of intensive treatment and high cost. We sought to estimate costs for the 21 most common cancers in Ontario in the 3-month period before and the first year after diagnosis. Methods: We used the Ontario Cancer Registry to select patients who received diagnoses between 1997 and 2007 at 19 years of age or older, with valid International Classification of Diseases for Oncology (ICD-O) and histology codes, who survived 30 days or longer after diagnosis and had no second cancer within 90 days of the initial cancer (n = 402 399). We used linked administrative data to calculate mean costs for each cancer during the pre- and postdiagnosis periods for patients who died within 1 year after diagnosis and patients who survived beyond 1 year after diagnosis. Results: Mean prediagnosis costs were $2060 (95$2023–$2098) for all patients with cancer. Costs ranged from$890 (95% CI $795–$985) for melanoma to $4128 (95$3591–$4664) for liver cancer among patients who survived beyond 1 year after diagnosis, and ranged from$2188 (95% CI $2040–$2336) for esophageal cancer to $5142 (95$4664–$5620) for multiple myeloma among patients who died within 1 year. The mean postdiagnosis cost for our cohort was$25 914 (95% CI $25 782–$26 046). Mean costs were lowest for melanoma ($8611 [95$8221–$9001]) and highest for esophageal cancer ($50 620 [95% CI $47 677–$53 562] among patients who survived beyond 1 year after diagnosis, and ranged from $27 560 (95$25 747–$29 373) for liver cancer to$81 655 (95% CI $58 361–$104 949) for testicular cancer among patients who died within 1 year. Interpretation Our research provides cancer-related cost estimates for the pre- and postdiagnosis phases and offers insight into the economic burden incurred by the Ontario health care system. These estimates can help inform policy-makers’ decisions regarding resource allocation for cancer prevention and control, and can serve as important input for economic evaluations

Serious Infections in a Population-Based Cohort of 86,039 Seniors With Rheumatoid Arthritis

Objective. To assess risk and risk factors for serious infections in seniors with rheumatoid arthritis (RA) using a case-control study nested within an RA cohort. Methods. We assembled a retrospective RA cohort age >66 years from Ontario health administrative data across 1992-2010. Nested case-control analyses were done, comparing RA patients with a primary diagnosis of infection (based on hospital or emergency department records) to matched RA controls. We assessed independent effects of drugs, adjusting for demographics, comorbidity, and markers of RA severity. Results. A total of 86,039 seniors with RA experienced 20,575 infections, for a rate of 46.4 events/1,000 person-years. The most frequently occurring events included respiratory infections, herpes zoster, and skin/soft tissue infections. Factors associated with infection included higher comorbidity, rural residence, markers of disease severity, and history of previous infection. In addition, anti-tumor necrosis factor agents and disease-modifying antirheumatic drugs were associated with a several-fold increase in infections, with an adjusted odds ratio (OR) ranging from 1.2-3.5. The drug category with the greatest effect estimate was glucocorticoids, which exhibited a clear dose response with an OR ranging from 4.0 at low doses to 7.6 at high doses. Conclusion. Seniors with RA have significant morbidity related to serious infections, which exceeds previous reports among younger RA populations. Rural residence, higher comorbidity, markers of disease severity, and previous infection were associated with serious infections in seniors with RA. Our results emphasize that many RA drugs may increase the risk of infection, but glucocorticoids appear to confer a particular risk

Trends in use and cost of initial cancer treatment in Ontario: a population-based descriptive study

BackgroundCancer incidence and treatment-related costs are rising in Canada. We estimated health care use and costs in the first year after diagnosis for patients with 7 common types of cancer in Ontario to examine temporal trends in patterns of care and costs.MethodsWe selected patients aged 19-44 years who had received a diagnosis of melanoma, breast cancer (female only), testicular cancer or thyroid cancer, in addition to patients aged 45 years and older who had received a diagnosis of breast (female only), prostate, lung or colorectal cancer, between 1997 and 2007. Patients were identified from the Ontario Cancer Registry. Using linked administrative databases, we determined use and costs of chemotherapy, radiotherapy, cancer-related surgery, other admissions to hospital and home care. We adjusted all costs to 2009 Canadian dollars.ResultsWe identified 20 821 patients aged 19-44 years and 178 797 patients aged 45 years and older. The greatest increases in costs during the study period were for melanoma, breast cancer, colorectal cancer, lung cancer and prostate cancer (p < 0.05). For prostate and lung cancers, mean costs increased 50% (from $11 490 and$22 037 to $15 170 and$34 473, respectively). Mean costs doubled for breast (from $15 460 and$12 909 to $35 977 and$29 362 for younger and older patients, respectively) and colorectal cancers (from $24 769 to$43 964), and nearly tripled for melanoma (from $3581 to$8934). Costs related to hospital admissions accounted for the largest portion of total costs. The use of chemotherapy, radiotherapy and home care generally increased for all cancers.InterpretationThe significant increase in mean costs of initial cancer treatment among the patients included in this study was primarily due to more patients receiving adjuvant therapy and home care, and to the increasing expenditures for these services and cancer-related surgeries. Understanding trends in health care use and costs can help policy-makers to take the necessary measures to achieve a more accountable, high-performing health care system

Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study

Objective To compare the incidence of admissions to hospital for stroke among older adults with dementia receiving atypical or typical antipsychotics. Design Population based retrospective cohort study. Setting Ontario, Canada. Patients 32 710 older adults (≤ 65 years) with dementia (17 845 dispensed an atypical antipsychotic and 14 865 dispensed a typical antipsychotic). Main outcome measures Admission to hospital with the most responsible diagnosis (single most important condition responsible for the patient's admission) of ischaemic stroke. Observation of patients until they were either admitted to hospital with ischaemic stroke, stopped taking antipsychotics, died, or the study ended. Results After adjustment for potential confounders, participants receiving atypical antipsychotics showed no significant increase in risk of ischaemic stroke compared with those receiving typical antipsychotics (adjusted hazard ratio 1.01, 95% confidence interval 0.81 to 1.26). This finding was consistent in a series of subgroup analyses, including ones of individual atypical antipsychotic drugs (risperidone, olanzapine, and quetiapine) and selected subpopulations of the main cohorts. Conclusion Older adults with dementia who take atypical antipsychotics have a similar risk of ischaemic stroke to those taking typical antipsychotics