Aleksandar Dagovic

Radiation therapy remains the key cost driver of oncology inpatient treatment

Abstract Objective: Current radiation therapy capacities in Serbia and most of Eastern Europe are heavily lagging behind population needs. The primary study aim was assessment of direct costs of cancer medical care for patients suffering from cancer with assigned radiotherapy-based treatment protocols. Identification of key cost drivers and trends during 2010–2013 comparing brachytherapy and teleradiotherapy was a secondary objective of the study. Methods: Retrospective, bottom-up database analysis was conducted on electronic discharge invoices. Payer’s perspective has been adopted with a 1-year long time horizon. Total sample size was 2544 patients during a 4-years long observation period (2010–2013). The sample consisted of all patients with confirmed malignancy disorder receiving inpatient radiation therapy in a large university hospital. Results: Diagnostics and treatment cost of cancer in the largest Western Balkans market of Serbia were heavily dominated by radiation therapy related direct medical costs. Total costs of care as well as mean cost per patient were steadily decreasing due to budget cuts caused by global recession. The paradox is that at the same time the budget share of radiotherapy increased for almost 15% and in value-based terms for €109 per patient (in total €109,330). Second ranked cost drivers were nursing care and imaging diagnostics. Costs of high-tech visualizing examinations were heavily dominated by nuclear medicine tests. Conclusion: The budget impact of radiation oncology to the large tertiary care university clinics of the Balkans is likely to remain significant in the future. Brachytherapy exhibited a slow growth pattern, while teleradiotherapy remained stable in terms of value-based turnover of medical services. Upcoming heavy investment into the national network of radiotherapy facilities will emphasize the unsatisfied needs. Huge contemporary budget share of radiotherapy coupled with rising cancer prevalence brings this issue into the hot spot of the ongoing cost containment efforts by local governments.

Macroeconomic Policy Impact On Oncology-Related Public Expenditure In An Emerging European Market – Signs Of Early Recovery

ABSTRACT Healthcare financing in Serbia has faced many challenges over the past few decades. One of the most severe challenges is a global macroeconomic recession whose far-reaching consequences deserve particular attention from policymakers in cases of the most demanding major prosperity diseases, such as cancer. The objective of the study was to assess the precise cost matrix of oncology medical care and its chronological evolution during the key years of the macroeconomic recessionary period during 2010-2013. A retrospective database of hospital discharge invoices was analysed, encompassing 37, 978 hospital admissions and 12, 505 patients during a four-year period. Insight into microeconomic patterns of consumption across groups of medical services was provided. A payers perspective and one-year time horizon have been adopted. Total hospital direct medical costs of cancer diagnostics and treatment in the observed tertiary care facility decreased from €7, 411, 446 in 2010 to €5, 715, 884 in 2012 and then increased to an extraordinary €8, 536, 364 in 2013. The costs of oncology nursing care, imaging diagnostics and radiotherapy have increased considerably while those of pharmaceuticals and surgery have decreased radically - completely transforming the resource allocation landscape of public cancer care. The financial burden of cancer in Serbia is considerable and, unfortunately, expected to increase further in the coming years. Worldwide economic recession and consecutive domestic policy constraints of reimbursement limitations have heavily affected the affordability of cancer treatment for ordinary citizens. Promising signs of market recovery are clearly visible in 2013, which will likely improve both access and equity of medical care in Serbian oncology clinics.

Five-year survival and costs of care in metastatic colorectal cancer: conventional versus monoclonal antibody-based treatment protocols.

Aim: To evaluate the costs and survival estimates of metastatic colorectal carcinoma patients treated with conventional cytostatic protocols and adjuvant monoclonal antibodies (mAbs). Methods: Retrospective randomized case series and cost-of-illness analysis was used. Metastatic colorectal carcinoma cases (62) were randomly selected from the archive of the largest university military hospital in Southeastern Europe. Results: A 6-month longer survival was attributed to mAbs (p = 0.581). Conventional protocols incurred €5137 (95% CI: €3758–€6517) versus €22,113 (95% CI: €16,201–€28,025) total direct medical costs in mAb-based group. ICER of €32,108 per life year gained attributable to mAbs three-fold exceeded informal willingness to pay threshold of Serbia. Conclusion: mAbs adjuvant protocols had modest positive impact on 5-year survival rates. Costs were driven by targeted biologicals, but significantly higher costs of care were recorded in mAb-treated group in other domains, as well. More selective prescription and reimbursement criteria should be applied to increase cost–effectiveness of targeted oncology agents.

Efficacy and safety of bevacizumab in combination with oxaliplatin, irinotecan and fluoropyrimidine-based therapy in advanced colorectal cancer

Methods: This was a controlled, prospective, multicentre, cohort study. Thirty patients with advanced colorectal cancer were enrolled into this study. Bevacizumab was applied with oxaliplatin-, irinotecan-, 5FU- or capecitabine -based chemotherapy in the first-, second- or third-therapy lines. Totally 261 cycles were applied. The median number of applied cycles per patient was 8 (range 2-16). Results: Objective tumor response (RR) was seen in 11 patients 37% (95%CI 19-69%) calculated on an intention-to-treat basis. The median duration of response was 12 months. Three of 11 patients (27%) with PR had secondary surgery. RR was seen in 9 of 16 patients (56%) who received bevacizumab in the first-line treatment and in 2 of 14 patients (14%) who received therapy in the second+ lines (p=0.02). Clinical benefit (PR+SD) was seen in 22 (74%) patients. 75% of patients achieved clinical benefit in the first-line and 74% in the second+ chemotherapy lines. The median time to progression (TTP) of the patients is was 9 + months (95%CI 7 - + ∞) at the moment of this analysis. The median TTP of patients who received bevacizumab in the first line was 11 months (95%CI 8 - + ∞). The median TTP of patients who received bevacizumab in the second+ lines was 5.5 months (95%CI 4 - + ∞) (p=0.015). The median survival time (OS) for all patients was 9 + months (95%CI 7 - + ∞). The median OS at the moment of analysis was 11 months (95%CI 9 - + ∞) for patients receiving bevaci- zumab in the first line, and 7 months for patients receiving the drug in the second+ lines (95%CI 6 - + ∞) (p=0.024). The incidence of any toxicity grade 3-4 was less than 10%. Bevacizumab associated incidence of grade 3-4 side effects did not exceed 5%. Hypertension 5% and thromboembolism 5% were the most frequent events. Gastrointestinal perforation did not occur. There was one toxic death due to sepsis and not directly associated with bevacizumab toxicity. Conclusion: Bevacizumab can safely be added to different chemotherapeutic regimens in first- and second+ line. The con- ferred benefit in overall survival, TTP and response rate obviously requires randomized trials.

Primary Small Cell Carcinoma Of Lung With Metachronous Breast Metastasis

Abstract Breast metastases from an extra-mammary malignancy are rare. Among the lung malignancies that metastasise in the breasts, previous literature has described approximately 30 cases of NSCLC and only a few cases of SCLC. Here, we present a 54-year-old woman with metachronous breast metastasis from pulmonary small cell carcinoma. She presented with a soft tissue mass in the right lung hilum. After bronchoscopy with biopsy, SCLC was verified. Th e patient was given 4 cycles of etoposide and cisplatin followed by radiation therapy. Seven months after the diagnosis of primary lung cancer, the patient palpated a mass in her right breast. Clinical examination and further diagnostics revealed the suspected malignancy, and a radical mastectomy was performed. Immunohistochemical findings suggested metastatic SCLC in the breast. Differentiation between primary and metastatic cancer in the breast is very important for therapeutic planning

Trends and Patterns of Disparities in Oral Cavity and Pharyngeal Cancer in Serbia: Prevalence and Economic Consequences in a Transitional Country

Citation: Djordjevic G, Dagovic A, Ristic V, Kanjevac T, Brajkovic D and Popovic M (2017) Trends and Patterns of Disparities in Oral Cavity and Pharyngeal Cancer in Serbia: Prevalence and Economic Consequences in a Transitional Country. Front. Pharmacol. 8:385. doi: 10.3389/fphar.2017.00385 Trends and Patterns of Disparities in Oral Cavity and Pharyngeal Cancer in Serbia: Prevalence and Economic Consequences in a Transitional Country