Exploring the healthcare cost implications of cancer stage. England level modelling

Transcription

1

2 Exploring the healthcare cost implications of cancer stage England level modelling Rachel White Thursday 22 nd September 2016

3 What we re covering Modelling methods Results - variation by stage and cancer type - patterns in spend per person - the impact of cancer progression Conclusions

4 Average monthly hospital cost Cost of care for cancer patients in England using HES Months since diagnosis Average monthly hospital costs in cohorts of patients surviving months, months, months, months and months from diagnosis. Mauro Laudicella, Brendan Walsh, Elaine Burns, Peter C Smith. Cost of care for cancer patients in England: evidence from population-based patient-level data. Br J Cancer 2016 May 12;114(11): Epub 2016 Apr 12.

5 Methods

6 Modelling the population Incidence Net survival by stage Background survival Stage at diagnosis Incident population - people diagnosed in 2015 in England Each patient is followed till either death or 15 years post diagnosis (2015 to 2030) Divided by stage at diagnosis and cancer type Treatment and care activities up to a maximum 15 years post diagnosis Population costs Cost per person

7 Modelling the costs with a pathway decision tree Diagnosis Treatment Follow up Transurethral Ultrasound % End of life care

8 Results

9 Spend on people with stage 4 disease varies by cancer Colorectal Pancreas Lung Stage at diagnosis: Spend on the population of patients diagnosed at stage 4 ( million) Kidney Prostate Bladder Melanoma Breast % 25% 50% 75% 100% % of total population cost for each cancer Population costs over 15 years for those diagnosed in 2015 by cancer type and stage at diagnosis Split by stage at diagnosis mainly based on 2012 data and assumptions for those with unknown stage.

10 Colorectal. Pancreas. Lung Reasons for the high spend on stage 4 disease patient numbers Costs Stage at diagnosis: Spend on the population of patients diagnosed at stage 4 ( million) 254 Numbers of people diagnosed at stage 4 Population 18,000 Costs 51 Population 3,000 Costs 204 Population 8,000 0% 50% 100% % of total cost/population Population costs over 15 years for those diagnosed in 2015 and the 2015 population by stage at diagnosis Split by stage at diagnosis mainly based on 2012 data and assumptions for those with unknown stage.

11 Cost per person Thousands Reasons for the high spend on stage 4 disease high cost per patient Colorectal Pancreas Melanoma Stage at diagnosis Costs per person over 15 years for those diagnosed in 2015

12 Total cost Millions Biological therapies have a big impact in colorectal cancer costs In stage 4 biological therapies account for 71% of systemic anti-cancer therapy - Stage 1 Stage 2 Stage 3 Stage 4 Pre-progression Metastatic disease CoT End of life Diagnosis Systemic anti-cancer therapy End of life Monitoring Treatment (excl. SACT) Consequences of treatment (CoT) Total cost in 2015 of people living with cancer in 2015 by stage and cost type People living with cancer in based on people with a cancer diagnosis in the 15 years before ( )

13 Millions Progressive disease also has an impact in colorectal cancer costs Cost of nonmetastatic disease Cost of metastatic and progressive disease Approximate number of 2015 cohort : Diagnosed at each stage Patients progressing over model period - Stage 1 Stage 2 Stage 3 Stage 4 Stage at diagnosis 5,900 9,400 10,300 8, ,200 3,300 Population costs over 15 years for those diagnosed in 2015 and the 2015 population by stage at diagnosis

14 Cost per person Thousands Examples of cancers where a stage 4 diagnosis has less impact on cost Breast Lung Bladder Testicular Stage at diagnosis Costs per person over 15 years for those diagnosed in 2015

15 Late stage disease after progression from stage 1-3 is also important Colorectal Breast Lung Care for people at stage 1-3 Care for people at stage 4 after progression from stage 1-3 Care for people diagnosed at stage 4 Bladder - 500,000,000 1,000,000,000 Total population cost Population costs over 15 years for those diagnosed in 2015 by stage at diagnosis and estimated progression

16 Colorectal Breast Non- Hodgkin Lymphoma Lung Pancreas Myeloma Prostate Hodgkin Lymphoma Kidney Bladder Total Example high cost consequences of treatment Total cost in 2015 of people living with cancer in 2015 ( millions) Post-surgical wound infection Anaemia Thrombocytopenia requiring platelet transfusion Bowel obstruction Mucositis Fertility preservation Biliary obstruction Complication with CVL Acute kidney injury New onset diabetes mellitus Severe sepsis/septic shock Sexual dysfunction Pneumonia Bowel incontinence Lymphoedema Kidney damage All People living with cancer in based on people with a cancer diagnosis in the 15 years before ( ). Total includes testicular cancer and glioma. CVL - Central Venous Line

17 Conclusions

18 Conclusions Share of population spend on people diagnosed with stage 4 disease varies by cancer type particularly high for colorectal, pancreas and lung For some cancers spend per person peaks at stage 4 but for many others there is no current peak at stage 4 Population spend on people who develop a metastasis after a period of living with stage 1 to 3 can be significant

19 Acknowledgments Clinicians who reviewed the assumptions

20