Article

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

University of Lyon, F-69007 Lyon, France.
BMC Health Services Research (impact factor: 1.66). 03/2012; 12:82. DOI:10.1186/1472-6963-12-82 pp.82
Source: PubMed

ABSTRACT 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.

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Keywords

4% annual discount rate
 
Average total costs
 
capture uncertainty
 
clinical practice guidelines
 
CONnective TIssue CAncer NETwork
 
cost-effectiveness analysis
 
costs
 
health costs
 
health economics
 
healthcare administrators
 
histological subtypes
 
incremental cost-effectiveness ratio
 
low incidence
 
microcosting approach
 
non adherence
 
non-parametric bootstrap method
 
probabilistic sensitivity analysis
 
relapse free survival
 
relapse-free survival
 
relapse-free year