Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada.
Department of Public Health Science, Queen's University, Kingston, ON K7L 3N6, Canada.
Curr Oncol. 2021 Apr 29;28(3):1681-1695. doi: 10.3390/curroncol28030157.
: Lung cancer (LC) care is resource and cost intensive. We launched a Multidisciplinary LC Clinic (MDC), where patients with a new LC diagnosis received concurrent oncology consultation, resulting in improved time to LC assessment and treatment. Here, we evaluate the impact of MDC on health resource utilization, patient and caregiver costs, and secondary patient benefits. : We retrospectively analyzed patients in a rapid assessment clinic with a new LC diagnosis pre-MDC (September 2016-February 2017) and post-MDC implementation (February 2017-December 2018). Data are reported as means; unpaired t-tests and ANOVA were used to assess for significance. We also conducted a cost analysis. Resource utilization, out-of-pocket costs, procedure-related costs, and indirect costs were evaluated from the societal perspective and presented in 2019 Canadian dollars (CAD); multi-way worst/best case and threshold sensitivity analyses were conducted. : We reviewed 428 patients (78 traditional model, 350 MDC). Patients in the MDC model required significantly fewer oncology visits from LC diagnosis to first LC treatment (1.62 vs. 2.68, < 0.001), which was significant for patients with stage 1, 3, and 4 disease. Compared with the traditional model, there was no change in mean biopsies/patient (1.32 traditional vs. 1.17 MDC, = 0.18) or staging investigations/patient (2.24 traditional vs. 2.02 MDC, = 0.20). Post-MDC, there was an increase in invasive mediastinal staging for patients with stage 2/3 LC (15.0% vs. 60.0%, < 0.001). Over 22 months, MDC resulted in savings of CAD 48,389 including CAD 24,167 CAD in direct patient out-of-pocket expenses. For the threshold analyses, MDC was estimated to cost CAD 25,708 per quality-adjusted life year (QALY), considered to be below current willingness to pay thresholds (at CAD 80,000 per QALY). MDC also facilitated oncology assessment for 29 non-LC patients. : An MDC led to a reduction in patient visits and direct patient and caregiver costs.
肺癌（LC）的治疗需要耗费大量的资源和资金。我们开设了一个多学科 LC 诊所（MDC），在这里，新诊断为 LC 的患者可以同时接受肿瘤学咨询，这使得 LC 评估和治疗的时间得到了改善。在这里，我们评估了 MDC 对卫生资源利用、患者和护理人员成本以及患者次要获益的影响。
我们回顾性分析了新诊断为 LC 的快速评估诊所患者的临床资料，这些患者在 MDC 实施前（2016 年 9 月至 2017 年 2 月）和 MDC 实施后（2017 年 2 月至 2018 年 12 月）分别接受治疗。数据以平均值表示；使用未配对 t 检验和方差分析来评估显著性。我们还进行了成本分析。从社会角度评估了资源利用、自付费用、与治疗相关的费用和间接费用，并以 2019 年加拿大元（CAD）表示；进行了多方向最差/最佳情况和阈值敏感性分析。
我们共回顾了 428 名患者（78 名采用传统模式，350 名采用 MDC 模式）。MDC 模式下的患者从 LC 诊断到首次 LC 治疗所需的肿瘤学就诊次数明显更少（1.62 次 vs. 2.68 次，<0.001），这对于 1 期、3 期和 4 期疾病患者尤为明显。与传统模式相比，每位患者的活检次数（1.32 次 vs. 1.17 次，=0.18）或分期检查次数（2.24 次 vs. 2.02 次，=0.20）没有变化。MDC 实施后，2/3 期 LC 患者的侵袭性纵隔分期检查有所增加（15.0% vs. 60.0%，<0.001）。在 22 个月的时间里，MDC 为每位患者节省了 48,389 加元的费用，包括节省了 24,167 加元的直接患者自付费用。对于阈值分析，MDC 估计每位患者的质量调整生命年（QALY）成本为 25,708 加元，被认为低于当前的支付意愿阈值（每 QALY 80,000 加元）。MDC 还为 29 名非 LC 患者提供了肿瘤学评估服务。
多学科 LC 诊所的建立降低了患者就诊次数和直接患者及护理人员的成本。
