EPICOST2 project
Epidemiological profiles and cost models of cancer patients - EPICOST2
Introduction
The EPICOST experience in quantifying and analyzing the cost of colorectal and breast cancer [Gigli et.al. 2021; Francisci et al. 2020], indicate that the costs in each of the phases of the disease (Initial, Continuous, Final) can be influenced by prevention strategies, the clinical approach and individual characteristics of the patient such as age, stage at diagnosis. Targeted public health interventions such as screening programs can have a positive return on the budget, as they change the amount and distribution of patient costs in the different stages of care. The assessment of adherence to clinical guidelines can be used to identify possible areas for investment and divestment while maintaining the quality of care for cancer patients constant [Dal Maso et al. 2014].
The project
The EPICOST2 project aims to replicate the experience made in the previous project to estimate the healthcare costs, in Italy, needed for the diagnosis and treatment of cancer patients on the basis of the number of patients who are affected by it and, in a certain period of time, are alive (prevalent cases) and are in specific stages of the disease. The method is applied to the most frequent tumor sites in adults and children. The estimates concern the Italian Cancer Registers (CR). Funded by the Ministry of Health, within the framework of the National Health Research Program 2017-2019, the EPICOST2 project was launched in May 2020. It has a three-year duration and is coordinated by the National Center for Disease Prevention and Health Promotion (CNaPPS formerly Cnesps) of the Istituto Superiore di Sanità (ISS) and sees as the Operating Units involved the Research Institute on Population and Social Policies of the National Research Council (IRPPS-CNR) and the Veneto Region. It makes use of the collaboration of experts in oncology, in the registration of tumors, in pharmaco-epidemiology and pharmaco-economics, in forecasts in relation to different scenarios of incidence and survival and aging of the population.
The general objective
The general objective of the project is to provide health policy decision makers with an analysis tool useful for resource planning, at a regional level, to be currently allocated to oncological diseases and which can also be used to plan future economic commitment.
Specific Aim 1
To estimate the overall amount of public health care resources allocated to cancer patients in regions covered by cancer registration, according to a three disease- phase pathway with initial, monitoring, and final phases.
Specif Aim 2
To forecast the number of cancer patients and corresponding health care expenditures in each phases of care (POC)
Specific Aim 3
To evaluate adherence to clinical guidelines and cost/effectiveness of selected health care interventions, such as the implementation of a screening program or the introduction of a new targeted therapy which may influence the amount and the distribution of cancer patients by POC as well as the cost per phase.
Material and methods
CR Veneto, Friuli Venezia Giulia, Naples participate in the project, providing data on cohorts of prevalent cases of cancer in adults (breast, lung, colon, rectum, prostate, non-Hodgkin's lymphoma, bladder, stomach, melanoma), CR Campania in the infant population (acute lymphoblastic leukemia, brain and central nervous system, Hodgkin's lymphoma), cross-sectional approach with data from various regional administrative archives (Hospital Discharge Forms, Outpatient Performance Forms, Flows from territorial and hospital Pharmaceuticals where available). The prevalence date for each patient cohort depends on the registration lenght of the individual registers. These data will allow us to determine, over time, how/which diagnostic-therapeutic procedures are delivered to each patient affected by the tumors studied within the public national health system. Starting from the individual data, the therapeutic and cost profiles of homogeneous patient groups by cancers site, stage at diagnosis, age class will be calculated. These profiles, applied to the estimated number of prevalent cases of these neoplasms among the residents in the various Italian areas, will allow to assess their relative health needs.
The project is supported by the Italian Ministry of Health
Written by Sandra Mallone - CNaPPS Istituto Superiore Sanità