Journal Article

Clinicians' adherence versus non adherence to practice guidelines in the management of patients with sarcoma: a cost-effectiveness assessment in two European regions

Coindre, Jean-Michel, Thiesse, Philippe, Buja, Alessandra, Biron, Pierre, Blay, Jean-Yves, Rossi, Carlo Riccardo, Ducimetière, Françoise, Decouvelaere, Anne-Valérie, Mastrangelo, Giuseppe, Sandonà, Paolo, Siani, Carole, Perrier, Lionel, Bergeron, Christophe, Ray-Coquard, Isabelle, Dei Tos, Angelo Paolo, Vecchiato, Antonella, Ranchère-Vince, Dominique, Gilly, François Noël

2012

Overview

Background Although the management of sarcoma is improving, non adherence to clinical practice guidelines (CPGs) remains high, mainly because of the low incidence of the disease and the variety of histological subtypes. Since little is known about the health economics of sarcoma, we undertook a cost-effectiveness analysis (within the CONnective TIssue CAncer NETwork, CONTICANET) comparing costs and outcomes when clinicians adhered to CPGs and when they did not. Methods Patients studied had a histological diagnosis of sarcoma, were older than 15 years, and had been treated in the Rhône-Alpes region of France (in 2005/2006) or in the Veneto region of Italy (in 2007). Data collected retrospectively for the three years after diagnosis were used to determine relapse free survival and health costs (adopting the hospital's perspective and a microcosting approach). All costs were expressed in euros (€) at their 2009 value. A 4% annual discount rate was applied to both costs and effects. The incremental cost-effectiveness ratio (ICER) was expressed as cost per relapse-free year gained when management was compliant with CPGs compared with when it was not. To capture uncertainty surrounding ICER, a probabilistic sensitivity analysis was performed based on a non-parametric bootstrap method. Results A total of 219 patients were included in the study. Compliance with CPGs was observed for 118 patients (54%). Average total costs reached 23,571 euros when treatment was in accordance with CPGs and 27,313 euros when it was not. In relation to relapse-free survival, compliance with CPGs strictly dominates non compliance, i.e. it is both less costly and more effective. Taking uncertainty into account, the probability that compliance with CPGs still strictly dominates was 75%. Conclusions Our findings should encourage physicians to increase their compliance with CPGs and healthcare administrators to invest in the implementation of CPGs in the management of sarcoma.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adherence / Aged / Biopsy / Cancer / Cancer therapies / Care and treatment / Catchment Area (Health) / Chemotherapy / Clinical practice guidelines / Colleges & universities / Compliance / Connective tissue / Consent / Cost analysis / Cost-Benefit Analysis / Cost-effectiveness / Disease-Free Survival / Drug Administration Schedule / Environmental health / Ethical aspects / Female / France / Guideline Adherence - standards / Health Administration / Health Informatics / Hospitalization / Hospitals / Human health and pathology / Humans / Italy / Life Sciences / Male / Medical imaging / Medical prognosis / Medicine / Medicine & Public Health / Melanoma / Metastasis / Middle Aged / Neoplasm Staging / Nursing Research / Oncology / Outcome and Process Assessment (Health Care) - economics / Outcome and Process Assessment (Health Care) - standards / Outpatient care facilities / Pathology / Patient outcomes / Patients / Pharmacists / Physicians (General practice) / Practice / Practice guidelines (Medicine) / Practice Guidelines as Topic - standards / Practice Patterns, Physicians' - standards / Practice Patterns, Physicians' - statistics & numerical data / Public Health / Radiation therapy / Research Article / Retrospective Studies / Sarcoma / Sarcoma - diagnosis / Sarcoma - economics / Sarcoma - therapy / Soft Tissue Neoplasms - diagnosis / Soft Tissue Neoplasms - economics / Soft Tissue Neoplasms - pathology / Soft Tissue Neoplasms - therapy / Surgery / Tumor Burden / Tumors / Variance analysis