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Economic evaluation analysis indicated imbalance in pediatric cancer treatment
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Applying economic evaluation tools, such as cost and cost-effectiveness analysis, to pediatric cancer treatments demonstrated an imbalance of tumor-directed therapy and supportive therapy evaluations, according to a recent literature review.
In particular, re-evaluating tumor-directed treatments — which predict the toxicities encountered and patients’ needs for supportive therapies — are expected to have a significant economic effect.
Despite a growing national focus on health care cost containment and accountability in resource utilization, childhood cancer therapy costs have continued to increase without matching survival improvements. In previous studies, economic evaluations were suggested as a method of identifying focal areas in which to improve resource efficiency.
Heidi V. Russell
“Increasing health care resource utilization and varied survival gains suggest that a portion of the increased utilization is not associated with improved outcomes,” Heidi V. Russell, MD, assistant professor in the department of pediatrics at the Baylor College of Medicine, and colleagues wrote. “Economic evaluation, or comparing treatments on the basis of monetary units, may provide decision makers with additional data to supplement medical-based outcomes.”
To identify and compare existing economic evaluations applied to childhood cancer therapies, Russell and colleagues performed a structured literature search of the Medline, PubMed and the National Health Service economic evaluation databases from 2000 to 2011.
Using the search concepts “cost analyses,” “child” and “cancer,” the researchers limited the 854 citations to those studies that exhibited original research, compared two or more treatments using monetary units and originated from economically developed countries. Studies that met the inclusion criteria were then assessed by the Drummond checklist and characterized by the therapy studied, research perspectives and data sources.
Forty studies met the inclusion criteria, 11 of which studied chemotherapy, surgery or radiation, and 29 of which studied supportive measures, including growth factor support or treatment of infection. Only 15 (36%) of the study cohort included treatment outcomes when comparing costs and researchers found that methodological limitations were common.
A wide variety of methodological limitations made direct comparisons between studies difficult, the researchers wrote. In particular, studies that did not clarify what costs were included or where the unit cost was derived prevented researchers from comparing data with other studies outside of their institution.
“Very few studies identified a statistically significant difference between treatments under comparison,” Russell and colleagues wrote. “[Economic evaluation] may require larger samples sizes than those needed to detect clinical difference, so the low number of patients on the studies reviewed likely limited the success. Studies from multiple institutions or use of models may help produce more reliable results, although each of these solutions has its own limitations.”
Disclosure: The researchers reported no relevant financial disclosures.
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