Economic Evaluation of a Geriatric Oncology Clinic.

Shabbir M H Alibhai,Uzair Malik,Kelvin K W Chan,Rana Jin,Arielle Berger,Lindy Romanovsky,Zuhair Alam,Padraig Warde,Ronak Saluja

doi:10.3390/cancers14030789

Abstract

Simple SummaryThere is increasing evidence supporting geriatric assessment (GA) prior to starting cancer treatment in older adults. However, GA is not widely available. One reason may be the lack of persuasive economic data demonstrating its value. We performed an economic evaluation of an academic geriatric oncology clinic and included 152 patients aged 65 years and older who underwent a GA in the pre-treatment setting. We carefully calculated the costs of the proposed treatment (prior to the GA), costs of the GA and associated recommendations, costs of the final treatment, and overall value. We found a GA saved CAD 7387 per patient seen. Extensive sensitivity analyses supported our finding that a GA is economically attractive and should be implemented more widely.Geriatric assessment (GA) is supported by recent trials and guidelines yet rarely implemented due to a lack of resources. We performed an economic evaluation of a geriatric oncology clinic. Pre-GA proposed treatments and post-GA actual treatments were obtained from a detailed chart review of patients seen at a single academic centre. GA-based costs for investigations and referrals were calculated. Unit costs were obtained for surgical, radiation, systemic therapy, laboratory, imaging, physician, nursing, and allied health care (all in 2019 Canadian dollars). A six-month time horizon and government payer perspective were used. Consecutive patients aged 65 years or older (n = 152, mean age 82 y) and referred in the pre-treatment setting between July 2016 and June 2018 were included. Treatment plans were modified for 51% of patients. Costs associated with planned treatment were CAD 3,655,015. Costs associated with GA and related interventions were CAD 95,798. Final treatment costs were CAD 2,436,379. Net savings associated with the clinic were CAD 1,122,837, or CAD 7387 per patient seen. Findings were robust in multiple sensitivity analyses. Combined with mounting trial data demonstrating the clinical benefits of GA, our data can inform a strong business case for geriatric oncology clinics in health care environments similar to ours, but additional studies in diverse health care settings are warranted.

Highlights

The majority of patients who develop cancer in industrialized nations are older adults (≥65 years)
We calculated the costs associated with the proposed treatment plan, added costs associated with the geriatric oncology assessment and related investigations, and subtracted the costs of the final treatment plan to determine the net cost of the geriatric oncology clinic
We found that the clinic was associated with a substantial cost saving of CAD 7387 per patient, primarily due to a reduction in treatment intensity and greater use of best supportive care alone

Summary

Introduction

The majority of patients who develop cancer in industrialized nations are older adults (≥65 years). Older adults with cancer face unique challenges due to decreased physiologic reserves, comorbidity, functional impairments, and cognitive impairments. The oncologic evidence base is usually limited. These factors challenge treatment decision making and lead to the potential for both over- and under-treatment [1]. Geriatric assessment (GA) allows for a more holistic evaluation of the patient and is recommended by several international authorities, including the International Society of Geriatric Oncology (SIOG) [2], the American Society of Clinical Oncology (ASCO) [3], and the National Comprehensive Cancer Network [4]. Based on emerging randomized trial evidence, GA and management are associated with reduced unplanned health care service use during cancer treatment [6,7,8]

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