Minimum Volume Standards for Surgical Care of Early-Stage Lung Cancer : A Cost-Effectiveness Analysis
Published by Elsevier Inc..
BACKGROUND: Multiple stakeholders have advocated for minimum volume standards for complex surgical procedures. The Leapfrog Group recommends that patients with non-small cell lung cancer (NSCLC) receive surgical resection at hospitals that perform at least 40 lung resections annually. However, the cost-effectiveness of this paradigm is unknown.
METHODS: A cost-effectiveness analysis was performed on 90-day and 5-year horizons for patients with clinical stage I NSCLC undergoing surgical resection at hospitals stratified by Leapfrog standard. Model inputs were derived from either the literature or a propensity score-matched cohort using the National Cancer Database. For the 5-year horizon, we simulated using a Markov model with 1-year cycle. Incremental cost-effectiveness ratio (ICER) was calculated to evaluate cost-effectiveness.
RESULTS: For the 90-day horizon, resection at a Leapfrog hospital was more costly ($25 567 vs $25 530) but had greater utility (0.185 vs 0.181 quality-adjusted life-years), resulting in an ICER of 10 506. Similarly, for the 5-year horizon, resection at a Leapfrog hospital was more costly ($26 600 vs $26 495) but more effective (3.216 vs 3.122 quality-adjusted life-years), resulting in an ICER of 1108. When the costs for long-distance travel, lodging, and loss of productivity for caregivers were factored in, the ICER was 20 499 during the 5-year horizon for resection at Leapfrog hospitals. Using a willingness-to-pay threshold of $50 000, resection at a Leapfrog hospital remained cost-effective.
CONCLUSIONS: Receiving surgery for clinical stage I NSCLC at hospitals that meet Leapfrog volume standards is cost-effective. Payers and policymakers should consider supporting patient and caregiver travel to higher volume institutions for lung cancer surgery.
| Errataetall: |
CommentIn: Ann Thorac Surg. 2023 Aug;116(2):442. - PMID 36746331 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:114 |
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| Enthalten in: |
The Annals of thoracic surgery - 114(2022), 6 vom: 01. Dez., Seite 2001-2007 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Subramanian, Melanie P [VerfasserIn] |
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Date Completed 29.11.2022 Date Revised 29.08.2023 published: Print-Electronic CommentIn: Ann Thorac Surg. 2023 Aug;116(2):442. - PMID 36746331 Citation Status MEDLINE |
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| doi: |
10.1016/j.athoracsur.2022.06.017 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM343015668 |
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| 100 | 1 | |a Subramanian, Melanie P |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Minimum Volume Standards for Surgical Care of Early-Stage Lung Cancer |b A Cost-Effectiveness Analysis |
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| 500 | |a Date Revised 29.08.2023 | ||
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| 500 | |a CommentIn: Ann Thorac Surg. 2023 Aug;116(2):442. - PMID 36746331 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Published by Elsevier Inc. | ||
| 520 | |a BACKGROUND: Multiple stakeholders have advocated for minimum volume standards for complex surgical procedures. The Leapfrog Group recommends that patients with non-small cell lung cancer (NSCLC) receive surgical resection at hospitals that perform at least 40 lung resections annually. However, the cost-effectiveness of this paradigm is unknown | ||
| 520 | |a METHODS: A cost-effectiveness analysis was performed on 90-day and 5-year horizons for patients with clinical stage I NSCLC undergoing surgical resection at hospitals stratified by Leapfrog standard. Model inputs were derived from either the literature or a propensity score-matched cohort using the National Cancer Database. For the 5-year horizon, we simulated using a Markov model with 1-year cycle. Incremental cost-effectiveness ratio (ICER) was calculated to evaluate cost-effectiveness | ||
| 520 | |a RESULTS: For the 90-day horizon, resection at a Leapfrog hospital was more costly ($25 567 vs $25 530) but had greater utility (0.185 vs 0.181 quality-adjusted life-years), resulting in an ICER of 10 506. Similarly, for the 5-year horizon, resection at a Leapfrog hospital was more costly ($26 600 vs $26 495) but more effective (3.216 vs 3.122 quality-adjusted life-years), resulting in an ICER of 1108. When the costs for long-distance travel, lodging, and loss of productivity for caregivers were factored in, the ICER was 20 499 during the 5-year horizon for resection at Leapfrog hospitals. Using a willingness-to-pay threshold of $50 000, resection at a Leapfrog hospital remained cost-effective | ||
| 520 | |a CONCLUSIONS: Receiving surgery for clinical stage I NSCLC at hospitals that meet Leapfrog volume standards is cost-effective. Payers and policymakers should consider supporting patient and caregiver travel to higher volume institutions for lung cancer surgery | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Yang, Zhizhou |e verfasserin |4 aut | |
| 700 | 1 | |a Chang, Su-Hsin |e verfasserin |4 aut | |
| 700 | 1 | |a Willis, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Jianrong |e verfasserin |4 aut | |
| 700 | 1 | |a Semenkovich, Tara R |e verfasserin |4 aut | |
| 700 | 1 | |a Heiden, Brendan T |e verfasserin |4 aut | |
| 700 | 1 | |a Kozower, Benjamin D |e verfasserin |4 aut | |
| 700 | 1 | |a Kreisel, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Meyers, Bryan F |e verfasserin |4 aut | |
| 700 | 1 | |a Patterson, G Alexander |e verfasserin |4 aut | |
| 700 | 1 | |a Nava, Ruben G |e verfasserin |4 aut | |
| 700 | 1 | |a Puri, Varun |e verfasserin |4 aut | |
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