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Cost-Utility Analysis of Major System Change in Specialist Cancer Surgery in London, England, Using Linked Patient-Level Electronic Health Records and Difference-in-Differences Analysis

Author

Listed:
  • Caroline S. Clarke

    (University College London)

  • Mariya Melnychuk

    (University College London)

  • Angus I. G. Ramsay

    (University College London)

  • Cecilia Vindrola-Padros

    (University College London)

  • Claire Levermore

    (Our Future Health)

  • Ravi Barod

    (Royal Free London NHS Foundation Trust)

  • Axel Bex

    (University College London)

  • John Hines

    (University College London Hospitals NHS Foundation Trust
    University College London, Cancer Collaborative
    Bart’s Health, NHS Trust)

  • Muntzer M. Mughal

    (University College London Hospitals NHS Foundation Trust)

  • Kathy Pritchard-Jones

    (University College London Hospitals NHS Foundation Trust
    UCL Partners Academic Health Science Network)

  • Maxine Tran

    (Royal Free Hospital
    University College London)

  • David C. Shackley

    ((hosted by) Christie NHS Foundation Trust
    Manchester Academic Health Science Centre, University of Manchester)

  • Stephen Morris

    (University of Cambridge)

  • Naomi J. Fulop

    (University College London)

  • Rachael M. Hunter

    (University College London)

Abstract

Background Studies have shown that centralising surgical treatment for some cancers can improve patient outcomes, but there is limited evidence of the impact on costs or health-related quality of life. Objectives We report the results of a cost-utility analysis of the RESPECT-21 study using difference-in-differences, which investigated the reconfiguration of specialist surgery services for four cancers in an area of London, compared to the Rest of England (ROE). Methods Electronic health records data were obtained from the National Cancer Registration and Analysis Service for patients diagnosed with one of the four cancers of interest between 2012 and 2017. The analysis for each tumour type used a short-term decision tree followed by a 10-year Markov model with 6-monthly cycles. Costs were calculated by applying National Health Service (NHS) Reference Costs to patient-level hospital resource use and supplemented with published data. Cancer-specific preference-based health-related quality-of-life values were obtained from the literature to calculate quality-adjusted life-years (QALYs). Total costs and QALYs were calculated before and after the reconfiguration, in the London Cancer (LC) area and in ROE, and probabilistic sensitivity analysis was performed to illustrate the uncertainty in the results. Results At a threshold of £30,000/QALY gained, LC reconfiguration of prostate cancer surgery services had a 79% probability of having been cost-effective compared to non-reconfigured services using difference-in-differences. The oesophago-gastric, bladder and renal reconfigurations had probabilities of 62%, 49% and 12%, respectively, of being cost-effective at the same threshold. Costs and QALYs per surgical patient increased over time for all cancers across both regions to varying degrees. Bladder cancer surgery had the smallest patient numbers and changes in costs, and QALYs were not significant. The largest improvement in outcomes was in renal cancer surgery in ROE, making the relative renal improvements in LC appear modest, and the probability of the LC reconfiguration having been cost-effective low. Conclusions Prostate cancer reconfigurations had the highest probability of being cost-effective. It is not clear, however, whether the prostate results can be considered in isolation, given the reconfigurations occurred simultaneously with other system changes, and healthcare delivery in the NHS is highly networked and collaborative. Routine collection of quality-of-life measures such as the EQ-5D-5L would have improved the analysis.

Suggested Citation

  • Caroline S. Clarke & Mariya Melnychuk & Angus I. G. Ramsay & Cecilia Vindrola-Padros & Claire Levermore & Ravi Barod & Axel Bex & John Hines & Muntzer M. Mughal & Kathy Pritchard-Jones & Maxine Tran &, 2022. "Cost-Utility Analysis of Major System Change in Specialist Cancer Surgery in London, England, Using Linked Patient-Level Electronic Health Records and Difference-in-Differences Analysis," Applied Health Economics and Health Policy, Springer, vol. 20(6), pages 905-917, November.
  • Handle: RePEc:spr:aphecp:v:20:y:2022:i:6:d:10.1007_s40258-022-00745-w
    DOI: 10.1007/s40258-022-00745-w
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    References listed on IDEAS

    as
    1. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
    2. Caroline S. Clarke & Cecilia Vindrola-Padros & Claire Levermore & Angus I. G. Ramsay & Georgia B. Black & Kathy Pritchard-Jones & John Hines & Gillian Smith & Axel Bex & Muntzer Mughal & David Shackle, 2021. "How to Cost the Implementation of Major System Change for Economic Evaluations: Case Study Using Reconfigurations of Specialist Cancer Surgery in Part of London, England," Applied Health Economics and Health Policy, Springer, vol. 19(6), pages 797-810, November.
    3. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
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