IDEAS home Printed from https://ideas.repec.org/a/spr/aphecp/v21y2023i2d10.1007_s40258-022-00771-8.html
   My bibliography  Save this article

Population-Level Impact of Omitting Axillary Lymph Node Dissection in Early Breast Cancer Women: Evidence from an Economic Evaluation in Germany

Author

Listed:
  • Hoa Thi Nguyen

    (Heidelberg University)

  • Manuela Allegri

    (Heidelberg University)

  • Jörg Heil

    (Heidelberg University
    Klinik St. Elisabeth)

  • André Hennigs

    (Heidelberg University
    Klinik St. Elisabeth)

Abstract

Background The American College of Surgeons Oncology Group Z0011 trial showed that complete axillary lymph node dissection (cALND) did not improve survival benefits in patients with one or two tumour-involved sentinel lymph nodes and undergoing breast conservation. Still, a considerable number of the Z0011-eligible patients continue to be treated with cALND in various countries. Given the potential economic gain from implementation of the Z0011 recommendations, we quantified population-level impacts of omitting cALND among Z0011-eligible patients in clinical practice. Methods This 2-year economic analysis adopted both the perspective of patients under statutory insurance and the societal perspective, using data collected prospectively from 179 German breast cancer units between 2008 and 2015. The estimation of cost savings and health gain relied on a single decision tree, which considered three scenarios: clinical practice at the baseline; actual implementation in routine care; and hypothetical full implementation in all eligible patients. Results Data for 188,909 patients with primary breast cancer were available, 13,741 (7.3%) of whom met the Z0011 inclusion criteria. The use of cALND decreased from 94.3% in 2010 to 46.9% in 2015, resulting in a gain of 335 quality-adjusted life-years and a saving of EUR50,334,756 for the society. Had cALND been omitted in all eligible patients, the total gain would have been more than double. Conclusions The implementation of the Z0011 recommendations resulted in substantial savings and health gain in Germany. Our findings suggest that it is beneficial to introduce additional policy measures to promote further uptake of the Z0011 recommendations in clinical practice.

Suggested Citation

  • Hoa Thi Nguyen & Manuela Allegri & Jörg Heil & André Hennigs, 2023. "Population-Level Impact of Omitting Axillary Lymph Node Dissection in Early Breast Cancer Women: Evidence from an Economic Evaluation in Germany," Applied Health Economics and Health Policy, Springer, vol. 21(2), pages 275-287, March.
  • Handle: RePEc:spr:aphecp:v:21:y:2023:i:2:d:10.1007_s40258-022-00771-8
    DOI: 10.1007/s40258-022-00771-8
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s40258-022-00771-8
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.

    File URL: https://libkey.io/10.1007/s40258-022-00771-8?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Sebastian Himmler & Jannis Stöckel & Job van Exel & Werner Brouwer, 2020. "The Value of Health - Empirical Issues when Estimating the Monetary Value of a QALY Based on Well-Being," SOEPpapers on Multidisciplinary Panel Data Research 1101, DIW Berlin, The German Socio-Economic Panel (SOEP).
    2. Zsolt Mogyorosy & Peter Smith, 2005. "The main methodological issues in costing health care services: A literature review," Working Papers 007cherp, Centre for Health Economics, University of York.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Pokhilenko, I. & Kast, T. & Janssen, L. M.M. & Evers, S. M.A.A. & Paulus, A. T.G. & Simon, J. & Mayer, S. & Berger, M. & Konnopka, A. & Muntendorf, L. & Brodszky, V. & García-Pérez, L. & Park, A-La & , 2023. "International comparability of reference unit costs of education services: when harmonizing methodology is not enough (PECUNIA project)," LSE Research Online Documents on Economics 117769, London School of Economics and Political Science, LSE Library.
    2. Carlos Rojas-Roque & Alfredo Palacios, 2023. "A Systematic Review of Health Economic Evaluations and Budget Impact Analyses to Inform Healthcare Decision-Making in Central America," Applied Health Economics and Health Policy, Springer, vol. 21(3), pages 419-440, May.
    3. Claudia Fischer & Susanne Mayer & Nataša Perić & Judit Simon, 2022. "Harmonization issues in unit costing of service use for multi-country, multi-sectoral health economic evaluations: a scoping review," Health Economics Review, Springer, vol. 12(1), pages 1-13, December.
    4. Banke-Thomas, Aduragbemi & Ayomoh, Francis & Aberjirinde, Ibukun-Oluwa & Banke-Thomas, Oluwasola & Eboreime, Ejemai Amaize & Ameh, Charles, 2021. "Cost of utilising maternal health services in low- and middle-income countries: a systematic review," LSE Research Online Documents on Economics 105081, London School of Economics and Political Science, LSE Library.
    5. Susanne Mayer & Michael Berger & Alexander Konnopka & Valentin Brodszky & Silvia M. A. A. Evers & Leona Hakkaart-van Roijen & Mencia R. Guitérrez-Colosia & Luis Salvador-Carulla & A-La Park & William , 2022. "In Search for Comparability: The PECUNIA Reference Unit Costs for Health and Social Care Services in Europe," IJERPH, MDPI, vol. 19(6), pages 1-15, March.
    6. Indrani Gupta & Mayur Trivedi & Vishal Jani & Kanksha Barman & Avantika Ranjan & Manas Sharma, 2021. "Costing Of Health And Wellness Centre A Case Study Of Gujarat," IEG Working Papers 415, Institute of Economic Growth.
    7. Reinhard Busse & Jonas Schreyögg & Peter C. Smith, 2008. "Variability in healthcare treatment costs amongst nine EU countries – results from the HealthBASKET project," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages 1-8, January.
    8. Eman A Hammad & Taissir Fardous & Ibrahim Abbadi, 2017. "Costs of hospital services in Jordan," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(4), pages 388-399, October.
    9. Abdelbaste Hrifach & Coralie Brault & Sandrine Couray-Targe & Lionel Badet & Pascale Guerre & Christell Ganne & Hassan Serrier & Vanessa Labeye & Pierre Farge & Cyrille Colin, 2016. "Mixed method versus full top-down microcosting for organ recovery cost assessment in a French hospital group," Health Economics Review, Springer, vol. 6(1), pages 1-7, December.
    10. Banke-Thomas, Aduragbemi & Aberjirinde, Ibukun-Oluwa & Ayomoh, Francis Ifeanyi & Banke-Thomas, Oluwasola & Eboreime, Ejemai Amaize & Ameh, Charles, 2020. "The cost of maternal health services in low-income and middle-income countries from a provider's perspective: a systematic review," LSE Research Online Documents on Economics 104344, London School of Economics and Political Science, LSE Library.
    11. Walsh, Brendan & Keegan, Conor & Brick, Aoife & Connolly, Sheelah & Bergin, Adele & Wren, Maev-Ann & Lyons, Seán & Hill, Leonie & Smith, Samantha, 2021. "Projections of expenditure for primary, community and long-term care Ireland, 2019–2035, based on the Hippocrates model," Research Series, Economic and Social Research Institute (ESRI), number RS126, August.
    12. Eduard Beck & Carlos Avila & Sofia Gerbase & Guy Harling & Paul Lay, 2012. "Counting the Cost of Not Costing HIV Health Facilities Accurately," PharmacoEconomics, Springer, vol. 30(10), pages 887-902, October.
    13. Shelley Potter & Charlotte Davies & Gareth Davies & Caoimhe Rice & William Hollingworth, 2020. "The use of micro-costing in economic analyses of surgical interventions: a systematic review," Health Economics Review, Springer, vol. 10(1), pages 1-11, December.
    14. Patrick Fahr & James Buchanan & Sarah Wordsworth, 2020. "A Review of Health Economic Studies Comparing Traditional and Massively Parallel Sequencing Diagnostic Pathways for Suspected Genetic Disorders," PharmacoEconomics, Springer, vol. 38(2), pages 143-158, February.
    15. Mads D. Faurby & Olaf C. Jensen & Lulu Hjarnoe & Despena Andrioti, 2017. "The costs of repatriating an ill seafarer: a micro-costing approach," Health Economics Review, Springer, vol. 7(1), pages 1-8, December.
    16. Leticia García-Mochón & Zuzana Špacírová & Jaime Espín, 2022. "Costing methodologies in European economic evaluation guidelines: commonalities and divergences," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(6), pages 979-991, August.
    17. M. Carreras & M. García-Goñi & P. Ibern & J. Coderch & L. Vall-Llosera & J. Inoriza, 2011. "Estimates of patient costs related with population morbidity: can indirect costs affect the results?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(4), pages 289-295, August.
    18. Frank G. Sandmann & Julie V. Robotham & Sarah R. Deeny & W. John Edmunds & Mark Jit, 2018. "Estimating the opportunity costs of bed‐days," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 592-605, March.
    19. Diriba Feyisa & Kiddus Yitbarek & Teferi Daba, 2021. "Cost of provision of essential health Services in Public Health Centers of Jimma zone, Southwest Ethiopia; a provider perspective, the pointer for major area of public expenditure," Health Economics Review, Springer, vol. 11(1), pages 1-15, December.
    20. Josephine C. Jacobs & Paul G. Barnett, 2017. "Emergent Challenges in Determining Costs for Economic Evaluations," PharmacoEconomics, Springer, vol. 35(2), pages 129-139, February.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:aphecp:v:21:y:2023:i:2:d:10.1007_s40258-022-00771-8. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.