bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing pregnancy screening prior to chemotherapy: A quality improvement initiative.
Authors: Rogers Brittany Kayla , Kolarich Andrew , Markham Merry Jennifer 
Published: September 2018

e18274 Background: ASCO’s QOPI sets standards for excellence in oncologic care. One standard is screening appropriate female patients for pregnancy prior to chemotherapy. No guidelines exist regarding screening protocols or timing. Prior data collection at our institution from 2012-2014 revealed that 35% of women of childbearing potential were screened prior to chemo, with medical oncology performing only 7% of screening. Less than half (48%) of those tests were ordered within 14 days prior to treatment start. Methods: A quality improvement (QI) intervention was implemented at UF Health outpatient infusion center on 8/15/16 based on the above data. A checkbox was added to the pre-chemo checklist used by infusion nurses. For eligible patients (women ages 18-55 without prior tubal ligation or hysterectomy), a point of care pregnancy test, included in standing orders, was recommended. We reviewed data for women who received outpatient chemo during 9/16-11/16 to determine rates of pregnancy screening (PS) after intervention. Results: 49 women, ages 18-55, of childbearing potential were identified and presented for 174 chemo cycles from 9/1/16 to 11/30/16. Of these, 15 (30.6%) received PS before chemo. Fifty pregnancy tests were ordered during this period; all were negative. Of the 50 tests, 42 (84%) were ordered by medical oncology, 3 (6%) by a surgical oncology, 3 (6%) by radiation oncology, and 1 (2%) by emergency medicine. Of the PS tests ordered by medical oncology, 64.2% were within 14 days of chemotherapy. Conclusions: In three months of QI intervention, PS prior to chemo increased from 7% to 30.6%. Screening was 13% in women older than 45, but higher in women age 25-34 (60%) and 35-44 (67%). Although the screening rate improved, it remains below our goal of 80%. Possible explanations for low rates are inclusion of postmenopausal women and those older than 50. Excluding these patients could reduce screening burden while identifying appropriate patients. [Table: see text]
Disease-management indicators to improve gastric and colorectal cancer control in the Colombian National Health System.
Authors: Valencia Omaira , Lopes Gilberto , Sánchez Quintero Patricia , Acuña Lizbeth , Gonzalez Jaime , Lopera Diego , Uribe Daniel , Pulido Diana 
Published: September 2018

e18288 Background: Gastric (GC) and colorectal cancer (CRC) are major health problems worldwide due to their high incidence and lethality associated with late presentation. The aim of this study was to develop a set of clinical, quality and administrative measures, for gastric and colorectal cancer based on evidence to assist health care insurers, providers and policy makers in controlling these diseases in Colombia. Methods: A systematic evidence-based literature search was performed to identify the initial list of indicators, which were then selected and developed using an adaptation of the RAND/UCLA appropriateness method by a panel of multidisciplinary expert panels with expertise in CRC and GC care, quality and public health. The following institutions participated in the study: The Ministry of Health and its High Cost Disease Office, medical professional societies, National Health Institute, Institute of evaluation of technologies in health, health care insurers and providers. A total of 1589 cases of GC and 2025 of CRC from the national administrative cancer registry, representing all new cases of these diseases in the country in 2015, were used to define the viability of the proposed measures, which the involved parties developed taking in consideration the whole disease spectrum from diagnosis to treatment. Results: After reviewing relevant articles and holding an in-person expert discussion the panel generated an initial proposed set of 45 disease-management indicators. A total of 15 disease-management measures for CRC and 16 for GC were developed and approved by the expert panel after two rounds of discussion and voting; these are related to opportunities to improve time between diagnoses to treatment and also include measures assessing clinical outcomes and administrative processes. Conclusions: We developed disease-management indicators for GC and CRC in a consensus with healthcare system stakeholders that are feasible and applicable in Colombia. In time, through continuous efforts towards improving the quality of care provided, these will allow all parties to monitor and decrease the burden of GC and CRC in the country and may serve as a model to other low and middle income countries.
Racial differences in the financial impact of breast cancer.
Authors: Wheeler Stephanie B. , Spencer Jennifer , Pinheiro Laura C , Carey Lisa A. , Olshan Andrew F , Reeder-Hayes Katherine Elizabeth 
Published: September 2018

e18293 Background: Racial variation in the adverse financial impact of cancer may contribute to observed differences in the initiation and completion of guideline-recommended adjuvant treatments. We describe racial differences in the financial impact of breast cancer diagnosis in a large, population-based, prospective cohort study. Methods: Patients were recruited via rapid case ascertainment through the North Carolina cancer registry as part of the Carolina Breast Cancer Study, with oversampling of black women and women younger than 50. Participants provided medical records and survey data on demographics, socioeconomic status, treatments, and financial impact of cancer. We used chi-square tests and multivariable logistic regression to understand racial differences in financial impact of breast cancer through 25 months post-diagnosis. Results: Our sample included 1,196 non-Hispanic blacks and 1,236 non-Hispanic whites. Since diagnosis, compared to white women, black women more often reported: any adverse financial impact of cancer (59% vs 39%, p < 0.0001); lost income (49% vs 35%, p < 0.0001); lost job due to cancer (13% vs 6%, p < 0.0001); financial barriers to treatment (24% vs 10%, p < 0.0001); transportation barriers to treatment (15% vs 3%, p < 0.0001); and lost health insurance (9% vs 3%, p < 0.0001). In multivariable models, black women had higher odds of: experiencing any adverse financial impact of cancer (Adjusted Odds Ratio [AOR]: 1.9 (1.6-2.3)); losing income (AOR: 1.5 (1.3-1.9)); losing their job (AOR: 2.1 (1.5-2.8)); experiencing financial barriers to treatment (AOR: 2.2 (1.7-2.9)); experiencing transportation barriers to treatment (AOR: 4.8 (3.2-7.1)); and losing their health insurance (AOR: 2.6 (1.7-4.1)). Conclusions: Compared to whites, black women with breast cancer experience significantly worse financial impact of cancer. Disproportionate financial strain may contribute to higher stress, lower treatment compliance, and worse outcomes, among black women. Efforts to alleviate the adverse financial impact of cancer treatment and to improve communication between patients and providers about potential financial distress may be particularly valuable for black women, due to their greater financial vulnerability.
Market capitalism in cancer pharmaceuticals.
Authors: Conter Henry Jacob 
Published: September 2018

e18295 Background: How can health technology assessments be deployed in a market-based healthcare system to improve value and sustainability? Methods: The pan-Canadian Oncology Drug Review (pCODR) is an evidence-based, cancer drug review process that guides formulary decision-making. As of 1/1/17, data from all 98 reviews and economic guidances were abstracted for price of medication, total health care cost per patient, cost-utility provided by the submitter and re-analysis by pCODR. Regression analysis identified correlations. Expected use of therapy was estimated employing data from the Canadian Cancer Society. An optimal formulary was developed, optimizing value for money. Results: Of the 98 reviews, 13 were not finalized, 3 were withdrawn, 1 was suspended. 4 reviews were excluded since the base-case was ambiguous. The median drug price per 28-day cycle was $7,567 (range $2,800-$18,435), with no annual difference from 2012-2016 (p = 0.49). The median best-estimate of cost-utility was $190,858/QALY (IQR $125,585/QALY) with a median net increase in health system cost of $62,771/patient (IQR $89,260) and 0.48 LYG/patient (range 0.04-2.43). Cost per 28-day cycle was a weak predictor of value (R² = 0.02, p < 0.01), and not of health system cost (R² = 0.14, p = 0.06). Funding all efficacious medications by a single payer insurance plan in Canada would require $5.91 billion producing 31,705 QALYs, annually. 26% of the cumulative budget would buy 41% of the health benefit, 56% of the budget would buy 70% of the effect. Once a budget is determined, new medication would replace drugs of higher cost per QALY. Employing this method increased QALY yield of the budget by 67%, 21%, 15%, and 14% at $1B, $2B, $3B, and $4B, respectively. The formulary turnover would be 66%, 44%, 37%, and 22% at each respective budget level. Conclusions: An optimized formulary requires practical deployment of HTA, the ability to shift resources across budgets, and the ability to continuously renegotiate prices based on incremental value. Future work is needed on publically acceptable divestment methods for lower value pharmaceuticals.
Bridging the financial assistance gap: A pilot study of a patient-facing app to identify drug financial assistance programs.
Authors: Zafar Yousuf , Manners Ian , Nicolla Jonathan , Friedman Fred , Gagosian Ben , Pollak Kathryn I. 
Published: September 2018

e18296 Background: Many cancer patients face high treatment-related costs and are often unaware of available financial resources. We designed “Bridge” as a stand-alone, smartphone app to reduce out-of-pocket treatment costs by connecting patients to tailored financial assistance programs. The goal of this pilot study was to evaluate the usability and preliminary effectiveness of Bridge. Methods: Eligible cancer patients were receiving anti-cancer treatment, owned a smartphone, and reported out-of-pocket treatment-related costs. Patients interacted with Bridge, inputted personal and financial data, and reviewed personalized financial resource results. Usability was assessed via the validated System Usability Scale (SUS). To be usable, patients would have to score at least 68 on the SUS. Effectiveness was assessed by two measures: “Bridge improved my knowledge about financial aspects of cancer care and what can be done about it” (1 = strongly disagree to 5 = strongly agree) and “Using this tool was helpful with my financial concerns” (1 = strongly disagree to 5 = strongly agree). Results: We enrolled 30 patients. 63% were female, 23% were non-white, 66% had greater than high school education, 97% were insured (48% Medicare), and 23% were employed. Median annual household income was $60,796. All patients completed a full interaction with the app, with median time to results of 116 seconds. 72% of patients matched to at least one currently open program, with patients matching to a median of 4 financial assistance programs. 90% of patients reported an SUS score of usable (i.e., > 68 out of 100). The median SUS score was 85. 83% of patients agreed or strongly agreed that “Bridge improved my knowledge about financial aspects of cancer care and what can be done about it.” 53% of patients agreed or strongly agreed that “Using this website was helpful with my financial concerns.” Conclusions: We found that patients rated Bridge as usable and acceptable. We also found that Bridge helped match most patients to relevant assistance programs and improved knowledge about financial aspects of cancer care. The next phase of this NCI-funded study will test the effectiveness of Bridge in a large, randomized, controlled trial.
Oncologists’ awareness, knowledge, and perceptions of value frameworks.
Authors: Wong William Bruce , Ravelo Arliene , DiBonaventura Marco , Shah-Manek Bijal 
Published: September 2018

e18317 Background: The increasing prevalence of cancer coupled with approvals of new drugs and technologies have brought increased scrutiny to cost/benefit of treatments in oncology. To address the rising concern about oncology drug costs, several stakeholders have developed frameworks to help assess the value of oncology regimens. The objective of this study was to assess oncologists’ perceptions, awareness and knowledge of all oncology value frameworks in the US. Methods: Data were collected from an electronic cross-sectional survey of 200 US-based oncologists recruited from an online panel. Oncologists were asked about their knowledge and perceptions of four value frameworks – the National Comprehensive Cancer Network’s (NCCN) Evidence Blocks, American Society of Clinical Oncology (ASCO) Value Framework, Institute for Clinical and Economic Review (ICER) Value Framework and Memorial Sloan Kettering (MSK) Drug Abacus framework. Findings were reported descriptively. Results: Oncologists were most familiar with the NCCN Evidence Blocks (90%) followed by the ASCO Value Framework (84%), ICER value framework (57%) and Drug Abacus (56%). Among those that were familiar with the value frameworks, almost equal proportions found the NCCN Evidence Blocks vs. ASCO Value Framework to be “useful/very useful” (75% vs. 74%) followed by ICER Value Framework (64%) and Drug Abacus (56%). More than three out of four oncologists surveyed (76%) had used value frameworks in the past, with NCCN Evidence Blocks being used most often (61.5%) followed by ASCO Value Framework (48.4%), ICER Value Framework (21%) and Drug Abacus (15%). NCCN Evidence Blocks was ranked highest for its ease of use, comprehensiveness, feasibility for use in the clinical setting, ability of patients to understand and most favorable overall, followed by ASCO Value Framework, ICER Value Framework and Drug Abacus. Conclusions: The majority of oncologists were familiar with value frameworks and had used them in the past. Of the four oncology Value Frameworks, NCCN Evidence Blocks were perceived most favorably by oncologists followed by ASCO Value Framework.
Budget impact model (BIM) to evaluate treatment costs associated with variable utilization rates of cabazitaxel in metastatic castration-resistant prostate cancer (mCRPC).
Authors: Drea Edward Joseph , Corman Shelby , Cockerham Alex R , Patel Miraj , Hudspeth Louis , Yu Andrew Kenneth 
Published: September 2018

e18321 Background: Cabazitaxel (CBZ) is a microtubule inhibitor indicated in combination with prednisone for treatment of patients with mCRPC previously treated with a docetaxel (DOC)-containing regimen. Recently published results of the PROSELICA trial may provide the basis for changing utilization rates of CBZ. Methods: A BIM was developed to project the overall costs of varying utilization rates of post-DOC treatment modalities for the management of mCRPC. Treatment costs of two dosage schema for CBZ were compared to abiraterone acetate, enzalutamide, and radium-223. Prevalence of mCRPC was estimated using US Census and population modeling data. Medication costs were derived from published benchmarks; dosing/monitoring information from prescribing information; and duration of therapy from published trials. Rates and costs of Grade 3 / 4 adverse events (AEs) per published trials were also incorporated. Results: In a hypothetical 1 million member US health plan, 100 pts are estimated to receive 2nd line (2L) treatment for mCRPC. Reported utilization rates for 2L agents calculate to a PMPM of $0.623. Following publication of the PROSELICA study, modeling a potential increase in CBZ 20 mg/m2 utilization from 0% to 7% and modeling a 12% to 16% utilization rate change for CBZ 25 mg/m2, costs are projected to decrease by -$0.022 PMPM or $265,033 over a one year period. Although AE costs of management calculate higher for the CBZ doses, lower monitoring and drug acquisition costs contribute to account for these findings (Table 1). Conclusions: Increasing utilization rates of CBZ in 2L mCRPC can result in a slight cost decrease due to variation in CBZ dosing and AE rates, and lower monitoring and acquisition costs. [Table: see text]
Impact of breast cancer treatments on cancer clinic resource utilization.
Authors: Gopalakrishnan Dharmesh , Goraya Shazia Tanvir , Banjac Svetlana , Yanda Courtney , Abraham Jame , Grobmyer Stephen R. , Pederson Holly Jane 
Published: September 2018

e18324 Background: Understanding clinic-based resource utilization among breast cancer (BC) patients is critical for the development of bundled payment models, and redesigning efficient value based systems of care delivery. BC outpatient visits (OVs) are costly from a time and human resource perspective and warrant investigation. Methods: This observational study included patients who were diagnosed with BC (Stages 0 to 3) in 2012 and were followed within our health network. Frequencies of OVs were compared between years 1, 2 and 3 of follow-up across subgroups, using one-sample Kolmogorov-Smirnov test; p < 0.05 was considered significant. Results: Of 643 patients identified, 83% were Caucasian and 99.5 % were females. 99.4% had breast surgery, 60% received radiation, and 42% received chemotherapy. 66% of patients who had mastectomy had reconstruction (73% implants, 27% tissue flap). The average duration of follow-up was 3.2 yrs. The frequency of OVs was highest in the 1st year after diagnosis across all groups in the Table (all p < 0.001). Breast reconstruction was associated with high clinic resource utilization; tissue flap procedures were associated with significantly more OVs than implant procedures during the 3 years (median of 16 vs.14 visits, p < 0.001). Conclusions: Outpatient visits represent a significant resource requirement associated with breast cancer care. These data are an important baseline as we design improved models of care and bundled payment models, and can be used to set expectations among breast cancer patients and care teams. [Table: see text]
Total 1-year cost of diffuse large B-cell lymphoma (DLBCL) beyond first line (1L) therapy: A retrospective cohort analysis.
Authors: Purdum Anna , Tieu Ryan , Reddy Sheila R. , Broder Michael 
Published: September 2018

e18333 Background: This cohort study estimated cost and healthcare use among DLBCL patients who progressed beyond 1L therapy. Methods: Using the MarketScan database, patients ≥18 years old who had R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) as 1L therapy and a claim for DLBCL (ICD-9-CM 200.7X) in the year before or 90 days after 1L start were selected for 2 cohorts: nonrelapsers who had no second line (2L) treatment for ≥2 years and 2L patients with non-R-CHOP chemotherapy after 1L. Patients not continuously enrolled for 6 months before and ≥2 years after 1L initiation, or those treated with maintenance rituximab or lenalidomide were excluded. 2L was subgrouped based on time between 1L end and 2L start: refractory (≤3 months), early (4-12 months), and late relapse (>12 months). Descriptive statistics compared cost and use between groups. Subsequent 2-year and 3-year data will be presented. Results: There were 217 (15.8%) 2L and 1,157 (84.2%) nonrelapse patients identified. Among 2L patients, 61 had hematopoietic stem cell transplant (HSCT) within 1 year. Of these HSCTs, 42.6% were early relapse patients vs. 24.6% late and 32.8% refractory (p=0.05). Mean total cost was $210,488 (SD $172,851) in 2L and $25,044 (SD $32,441) in non-relapsers (p<.001). Within 2L, mean total 1-yr cost was $232,796 in early relapse, $213,866 in late, and $191,079 in refractory (p=0.3314). For HSCT patients, cumulative 1-yr and 2-yr costs were $301,426 (Table) and $421,739. Conclusions: DLBCL treatment beyond 1L is resource intensive; chemotherapy and HSCT are major drivers of cost despite a low rate of HSCT. Cost in early relapsers may be higher than late relapsers or refractory patients due to higher transplant rates. [Table: see text]
Cost savings of conversion from filgrastim or pegfilgrastim to biosimilar filgrastim-sndz for chemotherapy-induced (febrile) neutropenia (CIN/FN) prophylaxis and expanded access to biosimilar GCSF on a budget neutral basis.
Authors: McBride Ali , Abraham Ivo , MacDonald Karen , Campbell Kim , Bikkina Mohan , Balu Sanjeev 
Published: September 2018

e18334 Background: Biosimilar filgrastim (Zarxio) provides a more cost-efficient alternative to reference and pegylated filgrastim for CIN/FN prophylaxis. Using biosimilar conversion rates, we determined savings achieved, number needed to convert (NNC) to purchase additional Zarxio, and the incremental number (n) of patients (pts) that could be provided Zarxio on a budget neutral basis using various filgrastim cycle/treatments scenarios. Prior real-world practice studies have shown variations in GCSF duration including shorter durations (Weycker 2006; Gascon 2016) relative to registration trials and guideline recommendations. Methods: Calculations were done for a panel of 20000 pts; chemotherapy of 1 or 6 cycles with 5, 7 or 11 filgrastim injections; cost of medicines using average selling price (Zarxio $245.08, Neupogen $283.87, Neulasta $3761.22) and subcutaneous administration per Current Procedural Terminology ($42.31 hospital outpt). NNC is the n to be converted to Zarxio to purchase 1 additional Zarxio dose or the full regimen. This yielded the incremental n that could receive any of the 6 prophylaxis scenarios budget neutrally. Results: See table below. Conclusions: A 20000 pt panel yields expanded access to Zarxio, on a budget-neutral basis, to 2699 additional pts if 100% are converted from Neupogen; and to 4063 to 32939 additional pts, depending on cycles/treatments, if converted from Neulasta. Weycker et al, Ann Pharmacother 2006;40:402-7. Gascon et al, Support Care Cancer 2016;24:911-25. [Table: see text]
Cost-effectiveness of nivolumab in advanced renal cell carcinoma.
Authors: Sarfaty Michal , Leshno Moshe , Gordon Noa , Moore Assaf , Neiman Victoria , Rosenbaum Eli , Goldstein Daniel A. 
Published: September 2018

e18338 Background: In recent years, new drugs have been introduced to the second line setting of advanced renal cell carcinoma (RCC). Nivolumab increases overall survival and is associated with less toxicity compared to everolimus in this setting based on the Checkmate 025 study. However, due to nivolumab's high cost there is a need to define its value by considering both efficacy and cost. The objective of this study was to estimate the cost-effectiveness of nivolumab for the second-line treatment of advanced RCC from the US payer perspective. Methods: A Markov model was developed to compare the costs and effectiveness of nivolumab with those of everolimus or placebo in the second-line treatment of advanced RCC. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were based on Medicare reimbursement rates in 2016. Model robustness was addressed in univariable and probabilistic sensitivity analyses. We addressed the controversial issue of the extensive duration of immunotherapy treatment amongst long term survivors, which may or may not be approved by payers. Results: The total mean cost per-patient of nivolumab versus everolimus was $101,070 and $50,935, respectfully. Nivolumab generated a gain of 0.24 LYs (0.34 QALYs) over everolimus and 0.89 LYs (0.96 QALYs) over placebo. The incremental cost-effectiveness ratio (ICER) for nivolumab was $146,532/QALY versus everolimus and $105,232/QALY versus placebo. Limiting the maximal treatment duration of nivolumab to two years lowered the ICER to $121,788/QALY versus everolimus and $96,418/QALY versus placebo. Conclusions: Our analysis established an ICER of $146,532/QALY for nivolumab versus everolimus in second-line advanced RCC treatment.