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The effect of health care expenditures on survival in locally advanced and metastatic Non Small Cell Lung Cancer

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Author Info

  • Lionel Perrier

    (GATE - Groupe d'analyse et de théorie économique - CNRS : UMR5824 - Université Lumière - Lyon II - Ecole Normale Supérieure Lettres et Sciences Humaines)

  • Magali Morelle

    (GATE - Groupe d'analyse et de théorie économique - CNRS : UMR5824 - Université Lumière - Lyon II - Ecole Normale Supérieure Lettres et Sciences Humaines)

  • Nathalie Havet

    ()
    (GATE - Groupe d'analyse et de théorie économique - CNRS : UMR5824 - Université Lumière - Lyon II - Ecole Normale Supérieure Lettres et Sciences Humaines)

  • Anthony Montella

    (Centre Léon Bérard - CRLCC Léon Bérard)

  • Bertrand Favier

    (Centre Léon Bérard - CRLCC Léon Bérard)

  • David Pérol

    (Centre Léon Bérard - CRLCC Léon Bérard)

  • Frédéric Gomez

    (Centre Léon Bérard - CRLCC Léon Bérard)

  • Marie-Odile Carrère

    (GATE - Groupe d'analyse et de théorie économique - CNRS : UMR5824 - Université Lumière - Lyon II - Ecole Normale Supérieure Lettres et Sciences Humaines)

  • Paul Rebattu

    (Centre Léon Bérard - CRLCC Léon Bérard)

Abstract

Context: The significant survival benefit of chemotherapy over best supportive care for locally advanced and metastatic NSCLC has been amply demonstrated in the literature. However, there is no clear evidence of the impact of the type of chemotherapy or of a superiority of combination chemotherapy over single-agent chemotherapy.Objective: The present study empirically examines, in real-life practise and using multiple proxies, the impact of health care expenditures on overall survival in locally advanced and metastatic NSCLC in order to guide medical decision-making.Methods: Disease characteristics, the resources used, the costs of treatment and survival data were retrospectively collected from the records of 175 patients treated between 2000 and 2004 at Léon Bérard Regional Cancer Center (Lyon, France). Survival data were modelled using multivariate Cox models and controlled for endogeneity with the instrumental variable method.Results: The median survival for the whole cohort was 289 days. The average total cost of treatment reached €35,160. Survival was significantly shorter for patients with stage IV disease, poor performance status, and past or concomitant cardiovascular disease and/or diabetes, for current smokers, and for patients with adenocarcinoma compared to large cell carcinoma. Survival duration was not significantly associated with the total cost of treatment per day of hospitalisation, the number of chemotherapy drugs administered, nor inpatient length of stay.Conclusion: Higher care expenditures do not appear to improve survival for patients with locally advanced or metastatic NSCLC. Hence, maintaining patient quality of life and tailoring therapy to stage, histology and comorbidities appears to be the less bad choice.

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File URL: http://halshs.archives-ouvertes.fr/docs/00/37/18/25/PDF/0903.pdf
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Bibliographic Info

Paper provided by HAL in its series Post-Print with number halshs-00371825.

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Date of creation: 2009
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Handle: RePEc:hal:journl:halshs-00371825

Note: View the original document on HAL open archive server: http://halshs.archives-ouvertes.fr/halshs-00371825/en/
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Related research

Keywords: Cost; NSCLC; Oncology; Survival;

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  1. Frank R. Lichtenberg, 2004. "The expanding pharmaceutical arsenal in the war on cancer," 2004 Meeting Papers, Society for Economic Dynamics 204, Society for Economic Dynamics.
  2. Martin, Stephen & Rice, Nigel & Smith, Peter C., 2008. "Does health care spending improve health outcomes? Evidence from English programme budgeting data," Journal of Health Economics, Elsevier, Elsevier, vol. 27(4), pages 826-842, July.
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