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      Cost‐effectiveness of the Collaborative Care to Preserve Performance in Cancer (COPE) trial tele‐rehabilitation interventions for patients with advanced cancers

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          Abstract

          Purpose

          The purpose of this analysis was to determine the cost‐effectiveness of a Collaborative Care Model (CCM)‐based, centralized telecare approach to delivering rehabilitation services to late‐stage cancer patients experiencing functional limitations.

          Methods

          Data for this analysis came from the Collaborative Care to Preserve Performance in Cancer (COPE) trial, a randomized control trial of 516 patients assigned to: (a) a control group (arm A), (b) tele‐rehabilitation (arm B), and (c) tele‐rehabilitation plus pharmacological pain management (arm C). Patient quality of life was measured using the EQ‐5D‐3L at baseline, 3‐month, and 6‐month follow‐up. Direct intervention costs were measured from the experience of the trial. Participants’ hospitalization data were obtained from their medical records, and costs associated with these encounters were estimated from unit cost data and hospital‐associated utilization information found in the literature. A secondary analysis of total utilization costs was conducted for the subset of COPE trial patients for whom comprehensive cost capture was possible.

          Results

          In the intervention‐only model, tele‐rehabilitation (arm B) was found to be the dominant strategy, with an incremental cost‐effectiveness ratio (ICER) of $15 494/QALY. At the $100 000 willingness‐to‐pay threshold, this tele‐rehabilitation was the cost‐effective strategy in 95.4% of simulations. It was found to be cost saving compared to enhanced usual care once the downstream hospitalization costs were taken into account. In the total cost analysis, total inpatient hospitalization costs were significantly lower in both tele‐rehabilitation (arm B) and tele‐rehabilitation plus pain management (arm C) compared to control (arm A), ( P = .048).

          Conclusion

          The delivery of a CCM‐based, centralized tele‐rehabilitation intervention to patients with advanced stage cancer is highly cost‐effective. Clinicians and care teams working with this vulnerable population should consider incorporating such interventions into their patient care plans.

          Abstract

          Cost‐effectiveness analyses conducted in parallel with a randomized clinical trial of 516 patients with late‐stage cancer assigned to: (a) a control group, (b) tele‐rehabilitation, and (c) tele‐rehabilitation plus pharmacological pain management found the second arm to be dominant, with an incremental cost‐effectiveness ratio of $15 494/QALY. When reduced health‐care utilization was considered, the tele‐rehabilitation arms were cost saving.

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          Most cited references20

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          History of the Rochester Epidemiology Project: half a century of medical records linkage in a US population.

          The Rochester Epidemiology Project (REP) has maintained a comprehensive medical records linkage system for nearly half a century for almost all persons residing in Olmsted County, Minnesota. Herein, we provide a brief history of the REP before and after 1966, the year in which the REP was officially established. The key protagonists before 1966 were Henry Plummer, Mabel Root, and Joseph Berkson, who developed a medical records linkage system at Mayo Clinic. In 1966, Leonard Kurland established collaborative agreements with other local health care providers (hospitals, physician groups, and clinics [primarily Olmsted Medical Center]) to develop a medical records linkage system that covered the entire population of Olmsted County, and he obtained funding from the National Institutes of Health to support the new system. In 1997, L. Joseph Melton III addressed emerging concerns about the confidentiality of medical record information by introducing a broad patient research authorization as per Minnesota state law. We describe how the key protagonists of the REP have responded to challenges posed by evolving medical knowledge, information technology, and public expectation and policy. In addition, we provide a general description of the system; discuss issues of data quality, reliability, and validity; describe the research team structure; provide information about funding; and compare the REP with other medical information systems. The REP can serve as a model for the development of similar research infrastructures in the United States and worldwide. Copyright © 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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            Use of a medical records linkage system to enumerate a dynamic population over time: the Rochester epidemiology project.

            The Rochester Epidemiology Project (REP) is a unique research infrastructure in which the medical records of virtually all persons residing in Olmsted County, Minnesota, for over 40 years have been linked and archived. In the present article, the authors describe how the REP links medical records from multiple health care institutions to specific individuals and how residency is confirmed over time. Additionally, the authors provide evidence for the validity of the REP Census enumeration. Between 1966 and 2008, 1,145,856 medical records were linked to 486,564 individuals in the REP. The REP Census was found to be valid when compared with a list of residents obtained from random digit dialing, a list of residents of nursing homes and senior citizen complexes, a commercial list of residents, and a manual review of records. In addition, the REP Census counts were comparable to those of 4 decennial US censuses (e.g., it included 104.1% of 1970 and 102.7% of 2000 census counts). The duration for which each person was captured in the system varied greatly by age and calendar year; however, the duration was typically substantial. Comprehensive medical records linkage systems like the REP can be used to maintain a continuously updated census and to provide an optimal sampling framework for epidemiologic studies.
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              Financial Toxicity of Cancer Care: It's Time to Intervene.

              S Zafar (2016)
              Evidence suggests that a considerably large proportion of cancer patients are affected by treatment-related financial harm. As medical debt grows for some with cancer, the downstream effects can be catastrophic, with a recent study suggesting a link between extreme financial distress and worse mortality. At least three factors might explain the relationship between extreme financial distress and greater risk of mortality: 1) overall poorer well-being, 2) impaired health-related quality of life, and 3) sub-par quality of care. While research has described the financial harm associated with cancer treatment, little has been done to effectively intervene on the problem. Long-term solutions must focus on policy changes to reduce unsustainable drug prices and promote innovative insurance models. In the mean time, patients continue to struggle with high out-of-pocket costs. For more immediate solutions, we should look to the oncologist and patient. Oncologists should focus on the value of care delivered, encourage patient engagement on the topic of costs, and be better educated on financial resources available to patients. For their part, patients need improved cost-related health literacy so they are aware of potential costs and resources, and research should focus on how patients define high-value care. With a growing list of financial side effects induced by cancer treatment, the time has come to intervene on the "financial toxicity" of cancer care.
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                Author and article information

                Contributors
                cheville.andrea@mayo.edu
                Journal
                Cancer Med
                Cancer Med
                10.1002/(ISSN)2045-7634
                CAM4
                Cancer Medicine
                John Wiley and Sons Inc. (Hoboken )
                2045-7634
                23 February 2020
                April 2020
                : 9
                : 8 ( doiID: 10.1002/cam4.v9.8 )
                : 2723-2731
                Affiliations
                [ 1 ] Division of Health Policy and Management University of Minnesota School of Public Health Minneapolis MN USA
                [ 2 ] Center for the Science of Health Care Delivery Mayo Clinic Rochester MN USA
                [ 3 ] Department of Physical Medicine and Rehabilitation Mayo Clinic Rochester MN USA
                Author notes
                [*] [* ] Correspondence

                Andrea L. Cheville, Mayo Clinic 200 First Street SW, Rochester, MN 55905, USA.

                Email: cheville.andrea@ 123456mayo.edu

                Author information
                https://orcid.org/0000-0002-5484-5004
                https://orcid.org/0000-0001-7668-6115
                Article
                CAM42837
                10.1002/cam4.2837
                7163089
                32090502
                0052d809-7b96-4c10-a3fa-9fb56e55fa56
                © 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 May 2019
                : 15 October 2019
                : 11 November 2019
                Page count
                Figures: 2, Tables: 4, Pages: 9, Words: 5711
                Funding
                Funded by: National Cancer Institute , open-funder-registry 10.13039/100000054;
                Award ID: R01 CA163803
                Categories
                Original Research
                Clinical Cancer Research
                Original Research
                Custom metadata
                2.0
                April 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.0 mode:remove_FC converted:17.04.2020

                Oncology & Radiotherapy
                cost effectivness,healthcare utilization,hospitalization,physical function,telecare

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