Health Policy and Management, DeGroote School of Business, McMaster University, Burlington, ON L7L 5R8, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, ON L8S 4L8, Canada.
Curr Oncol. 2022 Apr 2;29(4):2483-2489. doi: 10.3390/curroncol29040202.
Traditionally, economic evaluations are based on clinical trials with well-defined patient populations that exclude many patient types. By contrast, studies that incorporate general patient populations end up including those in lower income categories, some of whom have significant financial burdens (often described as financial toxicity) related to their care. Consideration of these patient burdens when examining the incremental cost-effectiveness of newer treatments from a clinical trial perspective can result in differing conclusions regarding cost-effectiveness. The challenge is to reliably assess the link between financial toxicity, quality of life and potential decisions to forego or delay care. It is also well-documented that these financial effects are not evenly distributed across populations, with those with low income and of black or Latino decent being most affected. There is a paucity of literature in this space, but some of the early work has suggested that for lung, breast, colorectal and ovarian cancers there are poorer quality-of-life scores and/or shorter overall survival for those experiencing financial toxicity. Hence, we may see both a lower quality of life and a shorter duration of life for these populations. If this is the case, additional considerations include: are the benefits of newer, more-expensive treatment strategies muted by the lack of adherence to these newer treatments due to financial concerns, and, if true, can these effects be effectively quantified as "real-world" outcomes? This rapid review examines these possibilities and the steps that may be required to examine this reliably.
传统上，经济评估基于具有明确患者群体的临床试验，这些试验排除了许多患者类型。相比之下，纳入一般患者群体的研究最终会包括收入较低的患者，其中一些人因治疗而承受着巨大的经济负担（通常被描述为财务毒性）。从临床试验的角度考虑这些患者负担，可能会对新治疗方法的增量成本效益产生不同的结论。挑战在于可靠地评估财务毒性、生活质量与潜在放弃或延迟治疗的决策之间的联系。也有充分的文献记载表明，这些经济影响在人群中分布不均，收入较低、黑人和拉丁裔人群受影响最大。在这个领域，文献相对较少，但一些早期的研究表明，对于肺癌、乳腺癌、结直肠癌和卵巢癌，经历财务毒性的患者生活质量评分较低，或总体生存率较短。因此，我们可能会看到这些人群的生活质量降低，寿命缩短。如果是这样，还需要额外考虑：由于财务问题导致对新的、更昂贵的治疗策略的依从性降低，是否会削弱这些新治疗策略的收益，而如果是这样，这些影响是否可以作为“真实世界”的结果进行有效量化？本快速综述探讨了这些可能性，以及为可靠地评估这些可能性可能需要采取的步骤。
