Adi Shani

RISK FACTORS FOR MATERNAL INTRAPARTUM FEVER AND SHORT-TERM NEONATAL OUTCOME

Our objective was to determine maternal risk factors for developing intrapartum fever during term labor and to evaluate perinatal outcomes for infants exposed to mothers with fever. We performed a retrospective cohort study of 330 mothers and their infants and 330 controls in a single institution. Prolonged labor, nulliparity, maternal disease, and prolonged membrane rupture were found to be the most significant predictors for developing intrapartum fever. Caesarean section and instrumental delivery were more commonly performed. Bacteriuria was present in 10 % of the mothers. Babies born to mothers with fever were more likely to have meconium-stained amniotic fluid. More babies in this group were symptomatic (mostly dyspnea) on admission. No cases of neonatal infection were recorded, and no severe morbidity or mortality was present. We concluded that in low-risk asymptomatic intrapartum fever, infection is the least common explanation. Perinatal outcomes may be influenced by medical decisions due to fever onset, such as delivery mode. Short-term outcomes are favorable.

Oncologists' and family physicians' views on value for money of cancer and congestive heart failure care.

BackgroundPrevious studies suggest that cancer-related interventions are valued by policy makers more favorably than interventions for other medical conditions, but the views of practicing physicians have not yet been assessed in Israel. Attitudes and judgments of practicing physicians may assist decision-makers in their deliberations on coverage of new technologies. We conducted a national survey in Israel among oncologists and family physicians to explore their views on access to care, coverage decisions and treatment recommendations for cancer and congestive heart failure (CHF) patients.MethodsWe administered a web-based survey to 300 family physicians and 156 oncologists. The questionnaire included 24 statements and physicians were asked to indicate their level of agreement with each statement on a 5-point Likert scale, ranging from “strongly agree” to “strongly disagree”. Where relevant, physicians were asked to express their views on interventions for cancer and CHF respectively.ResultsResponse rates were 39% for family physicians and 36% for oncologists. Participants expressed similar views on cancer and CHF care and no significant differences were found between the two medical specialties. More than 85% of physicians believe that inclusion of a treatment in the National List of Health Services (NLHS) strongly affects their patients’ access to care. Approximately 80% suggest that more use of comparative-effectiveness and cost-effectiveness analysis is needed in coverage decisions. The vast majority of respondents (75%) suggest that assessment of value-for-money should be made by an independent (academic) institution or the national committee responsible for recommending coverage decisions, Seventy percent believe that treatments not included in the NLHS should be included in supplementary health insurance programs and only a small minority of respondents (<30%) believe that cancer-related interventions should receive higher priority than non-cancer interventions in coverage decisions.ConclusionsOur findings suggest that both oncologists and family physicians value cancer and CHF interventions equally. We could not find evidence for a “cancer premium” as implied from previous surveys and analysis of coverage decisions in various countries.

Which Is More Valuable, Longer Survival or Better Quality of Life? Israeli Oncologists’ and Family Physicians’ Attitudes Toward the Relative Value of New Cancer and Congestive Heart Failure Interventions

OBJECTIVESnWe determined how Israeli oncologists and family physicians value life-prolongation versus quality-of-life (QOL)-enhancing outcomes attributable to cancer and congestive heart failure interventions.nnnMETHODSnWe presented physicians with two scenarios involving a hypothetical patient with metastatic cancer expected to survive 12 months with current treatment. In a life-prolongation scenario, we suggested that a new treatment increases survival at an incremental cost of

Impact of the 12-Gene Colon Cancer Assay on Clinical Decision Making for Adjuvant Therapy in Stage II Colon Cancer Patients

50,000 over the standard of care. Participants were asked what minimum improvement in median survival the new therapy would need to provide for them to recommend it over the standard of care. In the QOL-enhancing scenario, we asked the maximum willingness to pay for an intervention that leads to the same survival as the standard treatment, but increases patients QOL from 50 to 75 (on a 0-100 scale). We replicated these scenarios by substituting a patient with congestive heart failure instead of metastatic cancer. We derived the incremental cost-effectiveness ratio per quality-adjusted life-year (QALY) gained threshold implied by each response.nnnRESULTSnIn the life-prolongation scenario, the cost-effectiveness thresholds implied by oncologists were

Cetuximab in metastatic colorectal cancer

150,000/QALY and

502PDMOSAIC STUDY: ACTUALIZATION OF OVERALL SURVIVAL (OS) WITH 10 YEARS FOLLOW UP AND EVALUATION OF BRAF. BY GERCOR AND MOSAIC INVESTIGATORS

100,000/QALY for cancer and CHF, respectively. Cost-effectiveness thresholds implied by family physicians were

Effect of adding oxaliplatin to adjuvant 5-fluorouracil/leucovorin (5FU/LV) in patients with defective mismatch repair (dMMR) colon cancer stage II and III included in the MOSIAC study.

50,000/QALY regardless of the disease type. Willingness to pay for the QOL-enhancing scenarios was

P-146Colorectal cancer patients with lung-only metastases have a favorable prognosis irrespective of treatment

60,000/QALY and did not differ by physicians specialty or disease.nnnCONCLUSIONSnOur findings suggest that family physicians value life-prolonging and QOL-enhancing interventions roughly equally, while oncologists value interventions that extend survival more highly than those that improve only QOL. These findings may have important implications for coverage and reimbursement decisions of new technologies.

Are Israeli Adults Willing to Pay Higher Health Taxes for a Wider Coverage of Life-Extending Medications?

OBJECTIVESnTo evaluate the impact of the 12-gene Colon Cancer Recurrence Score Assay-a clinically validated prognosticator in stage II colon cancer after surgical resection-on adjuvant treatment decisions in T3 mismatch repair proficient (MMR-P) stage II colon cancer in clinical practice.nnnMETHODSnThis retrospective analysis included all patients with T3 MMR-P stage II colon cancer (Clalit Health Services members) with Recurrence Score results (time frame January 2011 to May 2012). Treatment recommendations pretesting were compared with the treatments received. Changes were categorized as decreased (to observation alone/removing oxaliplatin from the therapy) or increased (from observation alone/adding oxaliplatin to the therapy) intensity.nnnRESULTSnThe analysis included 269 patients; 58%, 32%, and 10% of the values were in the low (<30), intermediate (30-40), and high (≥41) score groups, respectively. In 102 patients (38%), treatment changed post-testing (decreased/increased intensity 76/26 patients). The overall impact was decreased chemotherapy use (45.0% to 27.9%; P < 0.001). Treatment changes occurred in all score groups, but more frequently in the high (change rate 63.0%; 95% confidence interval [CI] 42.3%-80.6%) than in the intermediate (30.6%; 95% CI 21.0%-41.5%) and low (37.6%; 95% CI 30.0%-45.7%) score groups. The direction of the change was consistent with the assay result, with increased intensity more common in higher score values and decreased intensity more common in lower score values.nnnCONCLUSIONSnTesting significantly affected adjuvant treatment in T3 MMR-P stage II colon cancer in clinical practice. The study is limited by its design, which compared treatment recommendations pretesting to actual treatments received post-testing, lack of a control group, and nonassessment of confounding factors that may have affected treatment decisions.