| アブストラクト | OBJECTIVES: This study aimed to explore the impact of revising suspected-cancer referral guidelines on primary care contacts and costs. METHODS: Participants had incident cancer (colorectal, n = 2000; ovary, n = 763; and pancreas, n = 597) codes in the Clinical Practice Research Datalink or England cancer registry. Difference-in-differences analyses explored guideline impacts on contact days and nonzero costs between the first cancer feature and diagnosis. Participants were controls ("old National Institute for Health and Care Excellence [NICE]") or "new NICE" if their index feature was introduced during guideline revision. Model assumptions were inspected visually and by falsification tests. Sensitivity analyses reclassified participants who subsequently presented with features in the original guidelines as "old NICE." For colorectal cancer, sensitivity analysis (n = 3481) adjusted for multimorbidity burden. RESULTS: Median contact days and costs were, respectively, 4 (interquartile range [IQR] 2-7) and pound117.69 (IQR pound53.23- pound206.65) for colorectal, 5 (IQR 3-9) and pound156.92 (IQR pound78.46- pound272.29) for ovary, and 7 (IQR 4-13) and pound230.64 (IQR pound120.78- pound408.34) for pancreas. Revising ovary guidelines may have decreased contact days (incidence rate ratio [IRR] 0.74; 95% confidence interval 0.55-1.00; P = .05) with unchanged costs, but parallel trends assumptions were violated. Costs decreased by 13% (equivalent to - pound28.05, - pound50.43 to - pound5.67) after colorectal guidance revision but only in sensitivity analyses adjusting for multimorbidity. Contact days and costs remained unchanged after pancreas guidance revision. CONCLUSIONS: The main analyses of symptomatic patients suggested that prediagnosis primary care costs remained unchanged after guidance revision for pancreatic cancer. For colorectal cancer, contact days and costs decreased in analyses adjusting for multimorbidity. Revising ovarian cancer guidelines may have decreased primary care contact days but not costs, suggesting increased resource-use intensity; nevertheless, there is evidence of confounding. |
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| ジャーナル名 | Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research |
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| 投稿日 | 2022/8/12 |
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| 投稿者 | Price, Sarah; Landa, Paolo; Mujica-Mota, Ruben; Hamilton, Willie; Spencer, Anne |
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| 組織名 | Discovery Unit, University of Exeter Medical School, University of Exeter,;Exeter, England, UK. Electronic address: s.j.price@exeter.ac.uk.;Departement d'operations et systemes de decision, Faculte des sciences de;l'administration, Universite Laval, Quebec City, QC, Canada; Centre Hospitaliere;Universitaire (CHU) de Quebec - Universite Laval, Quebec City, QC, Canada.;Academic Unit of Health Economics, University of Leeds, Leeds, England, UK.;Exeter, England, UK.;Health Economics Group, University of Exeter, Exeter, England, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/35953398/ |
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