Clinicians' adherence versus non adherence to practice guidelines in the management of patients with sarcoma: a cost-effectiveness assessment in two European regions
1 University of Lyon, F-69007 Lyon; CNRS, GATE Lyon-St Etienne, UMR n°5824, 69130 Ecully, Department Cancer and Environment, Cancer Centre Léon Bérard, 69008 Lyon, France
2 Department of Environmental Medicine and Public Health, University of Padova, 35122 Padova, Italy
3 Department of Environmental Medicine and Public Health, Padua University, 35122, Padova, Italy
4 Melanoma and Sarcomas Unit, Veneto Institute of Oncology, IOV, IRCCS, 35128, Padova, Italy
5 Department of Environmental Medicine and Public Health, Padua University, 35122 Padova, Italy
6 University of Lyon, Cancer Centre Léon Bérard; Santé-Individu-Société EA-INSERM 4129, 28 rue Laënnec, 69373 Lyon, Cedex 08, France
7 University of Lyon, Department of Medical Oncology, Cancer Centre Léon Bérard, 28 rue Laennec, 69373 Lyon, Cedex 08, France
8 Department of Digestive Surgery, University Hospital Lyon Sud, 165 Chemin du Grand Revoyet, 69310 Pierre Bénite, France
9 ERIC EA 3083, University of Lyon (University Claude Bernard Lyon 1), 69622 Lyon, France
10 University of Lyon, Cancer Centre Léon Bérard, Department of Medical Oncology, 28 rue Laënnec, 69373 Lyon, Cedex 08, France
11 Department of Anatomopathology, Centre Léon Bérard, 69373 Lyon, Cedex 08, France
12 Department of Anatomopathology, Centre Léon Bérard, 69373, Lyon, Cedex 08, France
13 Department of Imaging, Centre Léon Bérard, 69373 Lyon, Cedex 08, France
14 Institut d'Hémato-Oncologie Pédiatrique, 1, place Professeur Joseph Renaut, 69008 Lyon, France
15 Department of Pathology, Hospital of Treviso, Piazza Ospedale 1, 31100 Treviso, Italy
16 Department of Pathology, Institut Bergonie, 229 Cours De l'Argonne, 33076 Bordeaux, France
17 Melanoma and Sarcomas Unit, Veneto Institute of Oncology, IOV, IRCCS, University of Padova, 35128 Padova, Italy
18 University de Lyon, Centre Léon Bérard, Department of Medical Oncology, 28 rue Laennec, 69008 Lyon, INSERM EA 4129 « SIS », 28 rue Laennec, 69008 Lyon, France
BMC Health Services Research 2012, 12:82 doi:10.1186/1472-6963-12-82Published: 28 March 2012
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.
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.
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%.
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.