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Cost–Utility Estimations of Palliative Care in Patients With Pancreatic Adenocarcinoma: A Retrospective Analysis

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Abstract

Background

We earlier reported cost–utility estimates in patients who undergo resection aimed at cure for pancreatic carcinoma. The present study describes similar information on patients with unresectable tumors who experienced palliative care only.

Methods

A population-based cohort of patients with exocrine pancreatic adenocarcinoma during 1998–2005 was evaluated retrospectively (n = 444). Total direct health care costs at departments of surgery and oncology, for primary health care, and at hospice were achieved. Self-estimated health-related quality of life (HRQL) was assessed by the SF-36. A single preference-based utility index, SF-6D, was derived from SF-36 items to estimate quality-adjusted life years (QALYs). Results were compared to similar findings in a previously reported group of patients with pancreatic carcinoma resected for cure (n = 31).

Results

Palliative care patients (n = 305) had impaired HRQL particularly related to physical domains. The mean preference-based health utility index at diagnosis was 0.65 ± 0.02 [95 % confidence interval (CI) 0.61–0.69] compared to 0.77 ± 0.02 (95 % CI 0.75–0.79) in healthy reference individuals. Total direct health care costs were 50 % in patients on palliative care compared to costs for surgical R0 resections (23,701 and 50,950€, respectively). QALYs for 1 year from diagnosis were 0.2 (95 % CI 0.17–0.23) in patients on palliative care and 0.48 (95 % CI 0.44–0.54) in resection patients. Costs per QALY were 118,418€ and 106,146€, respectively (95 % CI 103,048–139,418€ and 94,352–115,795€).

Conclusions

Optimized palliative care of patients with exocrine pancreatic carcinoma had costs per achieved utility similar to those for surgical resections aimed at cure.

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Abbreviations

HRQL:

Health related quality of life

QALY:

Quality adjusted life year

SF-36:

Medical outcomes study short form 36

SF-6D:

Short form 6 dimensions

NICE:

National Institute for health and Clinical Excellence

US panel:

Panel on cost-effectiveness in health and medicine

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Acknowledgments

This study was supported in part by grants from the Assar Gabrielsson Foundation (AB Volvo), the Gothenburg Medical Society, the Swedish Government (LUA-ALF), the Swedish Cancer Society, and the Swedish Research Council (08712).

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Authors and Affiliations

  1. Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden

    David Ljungman, Anders Hyltander & Kent Lundholm

Authors
  1. David Ljungman
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  2. Anders Hyltander
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  3. Kent Lundholm
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Correspondence to Kent Lundholm.

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Ljungman, D., Hyltander, A. & Lundholm, K. Cost–Utility Estimations of Palliative Care in Patients With Pancreatic Adenocarcinoma: A Retrospective Analysis. World J Surg 37, 1883–1891 (2013). https://doi.org/10.1007/s00268-013-2003-z

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