Short-Term cost impact of compliance with clinical practice guidelines for initial sarcoma treatment

Lionel Perrier (1, 2, 3) , Nicola Cautela (1, 4) , Magali Morelle (1, 2, 3) , Nathalie Havet (1, 3) , Françoise Ducimetière (1, 2) , Antoine Lurkin (1, 5) , Jean-Yves Blay (1, 6) , Pierre Biron (1, 2) , Dominique Ranchère-Vince (1, 2) , Anne-Valérie Decouvelaere (1, 2) , Philippe Thiesse (1, 2) , Christophe Bergeron (1, 2) , François Gilly (1, 7) , Guy de Laroche (8) , Dominic Cellier (9) , Mathieu Laramas (10) , Thierry Philip (1, 2) , Isabelle Ray-Coquard (1, 5)

1 Université de Lyon
2 Centre Léon Bérard [Lyon]
3 GATE - Groupe d'analyse et de théorie économique
4 LEFI - Laboratoire d'Economie de la Firme et des Institutions
5 SIS - Santé Individu Société
6 Oncogénèse et progression tumorale
7 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
8 Institut de Cancérologie de la Loire Lucien Neuwirth
9 Merck Santé - Lyon
10 CHU de Grenoble - Centre hospitalier universitaire de Grenoble

Background: The impact of compliance to clinical practice guidelines (CPG) on outcomes and/or costs of care has not been completely clarified.
Objective: To estimate relationships between medical expenditures and compliance to CPG for initial sarcoma treatment.
Research design: Selected cohorts of patients diagnosed with sarcoma in 2005 and 2006, and treated at the University hospital and/or the cancer centre of the Rhône-Alpes region, France (n=90). Main outcome measurements were: patient characteristics, compliance with CPG, health outcomes, and costs. Data were mainly extracted from patient records. The logarithm of treatment costs was modelled using linear and Tobit regressions.
Results: Rates of compliance with CPG were 86%, 66%, 88%, 89%, and 95% for initial diagnosis, primary surgical excision, wide surgical excision, chemotherapy, and radiotherapy, respectively. Total average costs reached €24,439, with €1,784, €11,225, €10,360, and €1,016 for diagnosis, surgery (primary and wide surgical excisions), chemotherapy, and radiotherapy, respectively. Compliance of diagnosis with CPG decreased the cost of diagnosis, whereas compliance of primary surgical excision increased the cost of chemotherapy. Compliance of chemotherapy with CPG decreased the cost of radiotherapy.
Conclusion: Since chemotherapy is one of the major cost drivers, these results support that compliance with guidelines increases medical care expenditures in short term.

Mots clés: Oncology; Sarcoma; Cost; Clinical guidelines; Efficacy; Medical Practices; Government Policy; Regulation; Public Health

Domaines: Economies et finances

Lionel Perrier, Nicola Cautela, Magali Morelle, Nathalie Havet, Françoise Ducimetière, et al.. Short-Term cost impact of compliance with clinical practice guidelines for initial sarcoma treatment. 2008. ⟨halshs-00322614⟩