Buja Alessandra, Sartor Gino, Scioni Manuela, Girardi Giovanni, Vecchiato Antonella, Bolzan Mario, Rebba Vincenzo, Chiarion Sileni Vanna, Palozzo Angelo Claudio, Montesco Maria, Del Fiore Paolo, Baldo Vincenzo, Rossi Carlo Riccardo
Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Department of Statistical Sciences, University of Padua, Padua, Italy -
G Ital Dermatol Venereol. 2020 Dec;155(6):764-771. doi: 10.23736/S0392-0488.18.06106-0. Epub 2018 Nov 9.
While many evidence-based pathways have been introduced to drive quality improvements in cancer care, most of these do not include evidence about their affordability. The main aim of this study was to provide an estimation of the overall budget to cover all the needs of melanoma patients in Veneto Region, managed according to the clinical pathway defined by the Rete Oncologica Veneta. A second objective is to conduct a cost-consequence analysis, comparing two different treatments.
A very detailed whole-disease model was developed describing the patient's pathway from diagnosis through the first year of follow-up. Each procedure involved in the model was associated with a likelihood measure and a cost. The model can be used to estimate the expected direct costs associated with melanoma.
We can observe that 0 and I stage, despite accounting for a huge percentage of new melanoma cases are characterized by a small percentage of the total costs. Stage III can be considered as the most expensive stage accounting for 54% of the total costs with a 12% of patients. Finally, the stage IV patients, although very few accounts for almost the 7% of the total costs. Regarding the cost-consequence analysis, it was estimated that the therapies introduced in 2016 led to an approximately 14% increase in the total costs.
Modeling a clinical pathway with a high level of detail enables to identify the main sources of spending. The consequent analysis can thus help policymakers to plan the future resources allocation.
虽然已经引入了许多基于证据的途径来推动癌症护理质量的提高，但其中大多数都没有包含关于其可负担性的证据。本研究的主要目的是估计覆盖威尼托地区所有黑色素瘤患者需求的总体预算，这些患者按照威尼托肿瘤网络定义的临床途径进行管理。第二个目标是进行成本-后果分析，比较两种不同的治疗方法。
开发了一个非常详细的全疾病模型，描述了患者从诊断到随访第一年的病程。模型中涉及的每个程序都与一个可能性度量和成本相关联。该模型可用于估计与黑色素瘤相关的预期直接成本。
我们可以观察到，0期和I期尽管占新黑色素瘤病例的很大比例，但在总成本中所占比例很小。III期可被视为最昂贵的阶段，占总成本的54%，患者占12%。最后，IV期患者虽然很少，但几乎占总成本的7%。关于成本-后果分析估计，2016年引入的治疗方法使总成本增加了约14%。
对临床途径进行高度详细的建模能够识别主要支出来源。因此，后续分析可以帮助政策制定者规划未来的资源分配。
