Antal Zemplényi

Cost-effectiveness analysis of intensity-modulated radiation therapy with normal and hypofractionated schemes for the treatment of localised prostate cancer

The aim of our analysis was to compare the cost-effectiveness of high-dose intensity-modulated radiation therapy (IMRT) and hypofractionated intensity-modulated radiation therapy (HF-IMRT) versus conventional dose three-dimensional radiation therapy (3DCRT) for the treatment of localised prostate cancer. A Markov model was constructed to calculate the incremental quality-adjusted life years and costs. Transition probabilities, adverse events and utilities were derived from relevant systematic reviews. Microcosting in a large university hospital was applied to calculate cost vectors. The expected mean lifetime cost of patients undergoing 3DCRT, IMRT and HF-IMRT were 7,160 euros, 6,831 euros and 6,019 euros respectively. The expected quality-adjusted life years (QALYs) were 5.753 for 3DCRT, 5.956 for IMRT and 5.957 for HF-IMRT. Compared to 3DCRT, both IMRT and HF-IMRT resulted in more health gains at a lower cost. It can be concluded that high-dose IMRT is not only cost-effective compared to the conventional dose 3DCRT but, when used with a hypofractionation scheme, it has great cost-saving potential for the public payer and may improve access to radiation therapy for patients.

The effect of performance-volume limit on the DRG based acute care hospital financing in Hungary

OBJECTIVES The aim of our paper is to analyse the effect of the so-called performance volume limit (PVL) financing method on acute hospital care. DATA AND METHODS The data were derived from the nationwide administrative dataset of the National Health Insurance Fund Administration (OEP) covering the period 2003-2008. We analysed the trends in the DRG cost-weights, number of cases, case-mix, and average length of stay. We calculated the average annual reimbursement rate per DRG cost-weight with and without the application of PVL degression according to the hospital type and medical professions. RESULTS Our results showed that although the national case mix (i.e., the sum of all of the DRG cost-weights produced in one year) did not change between 2003-2006, the trend of the annual number of cases increased, and the average length of stay decreased. During 2007-2008, a significant decline was found in each indicator. The introduction of the PVL resulted in a health insurance budget saving of 1.9% in 2004, 2.6% in 2005, 3.4% in 2006, 5.6% in 2007, and 3.2% in 2008. We found the lowest reimbursement rate per DRG cost-weight at the university medical schools (HUF 138,200 or € 550) and childrens hospitals (HUF 132,547 or € 528), whereas the highest was at the county hospitals (HUF 143,451 or € 571) and city hospitals (HUF 142, 082 or € 565). CONCLUSIONS The implementation of the PVL reduced the acute care hospital activity and reimbursement. The effect of the PVL was different on the different types of hospitals, and it had a serious disadvantageous effect on the university medical schools and childrens hospitals.

Az első onkológiai ellátás időfaktorának szerepe a daganatos betegségek túlélési mutatóiban. Irodalmi áttekintés

Absztrakt: A szerzők celja a felnőttkori szolid tumoroknal a műtetre, illetve definitiv onkologiai kezelesre valo varakozas szerepenek tisztazasa volt. Ennek erdekeben az orvosi szakirodalom attekintesevel, 67 retrospektiv vizsgalat, illetve osszefoglalo munka elemzesevel felmertek az időfaktor, azaz a diagnozist kovető kezelesinditas statisztikailag szamszerűsithető hatasat a teljes tulelesre. Az időfaktornak biztosan komoly szerepe van a biologiailag agresszivebb betegsegeknel, peldaul fiatalkori emlő- es hereraknal vagy fej-nyaki tumoroknal, de az első onkologiai ellatas nehany napos es indokolt megkesese nem negativ hatasu a legtobb szolid daganatos betegsegben. A kivizsgalas, illetve a kezelesinditas menetet tobb orvosi es pszichoszocialis tenyező alakithatja, es sokszor eppen a legelőrehaladottabb korkepek ellatasa tortenik meg korabban, inverz tulelesi hatast eredmenyezve. Az onkologiai kezelesek eredmenyesseget alapvetően az optimalis terapiavalasztas hatarozza meg, mindazonaltal az időfaktor szer...

Defining good health and care from the perspective of persons with multimorbidity: Results from a qualitative study of focus groups in eight European countries

Objectives The prevalence of multimorbidity is increasing in many Western countries. Persons with multimorbidity often experience a lack of alignment in the care that multiple health and social care organisations provide. As a response, integrated care programmes are appearing. It is a challenge to evaluate these and to choose appropriate outcome measures. Focus groups were held with persons with multimorbidity in eight European countries to better understand what good health and a good care process mean to them and to identify what they find most important in each. Methods In 2016, eight focus groups were organised with persons with multimorbidity in: Austria, Croatia, Germany, Hungary, the Netherlands, Norway, Spain and the UK (total n=58). Each focus group followed the same two-part procedure: (1) defining (A) good health and well-being and (B) a good care process, and (2) group discussion on prioritising the most important concepts derived from part one and from a list extracted from the literature. Inductive and deductive analyses were done. Results Overall, the participants in all focus groups concentrated more on the care process than on health. Persons with multimorbidity defined good health as being able to conduct and plan normal daily activities, having meaningful social relationships and accepting the current situation. Absence of shame, fear and/or stigma, being able to enjoy life and overall psychological well-being were also important facets of good health. Being approached holistically by care professionals was said to be vital to a good care process. Continuity of care and trusting professionals were also described as important. Across countries, little variation in health definitions were found, but variation in defining a good care process was seen. Conclusion A variety of health outcomes that entail well-being, social and psychological facets and especially experience with care outcomes should be included when evaluating integrated care programmes for persons with multimorbidity.

A prosztatadaganatos betegek sugárterápiájának mikroköltség-számítása

Absztrakt Bevezetes: A technologia fejlődese uj lehetősegeket nyitott a prosztatadaganat sugarkezelese teren, ugyanakkor kevesse ismert a korszerű technologia koltsege. Celkitűzes: Jelen elemzes celja, hogy osszehasonlitsa a haromdimenzios konformalis sugarterapia, a normal- es hipofrakcionalt intenzitasmodulalt sugarterapia koltseget lokalizalt prosztatarakos betegek kezeleseben. Modszer: A retrospektiv koltsegelemzes egy hazai onkologiai centrum adatai alapjan keszult az egeszsegugyi szolgaltato szemszogeből. Az irradiacio időtartamat 20 beteg osszesen 100 kezelesi frakciojanak egyedi merese alapjan hataroztak meg. Az egysegkoltsegeket az intezmeny kontrollingrendszere alapjan szamitottak ki. Eredmenyek: Egy frakcio atlagos időtartama a hagyomanyos haromdimenzios konformalis sugarterapia eseten 14,5 perc, intenzitasmodulalt sugarterapia eseten kepvezerelt eljarassal 16,2 perc, mig kepvezerelt eljaras nelkul 14 perc volt. A kezeles teljes koltsege haromdimenzios konformalis sugarterapia eseten 619 ezer f...

A korszerű sugárterápiás kezelések mellékhatásainak metaanalízise prosztatarákos betegeknél

Absztrakt Bevezetes: A sugarterapia technologiai fejlődesenek egyik celterulete a prosztatarak megfelelő sugaras ellatasa. Celkitűzes: Az elemzes celja a normalfrakcionalasu es a hipofrakcionalt, illetve a konvencionalis es a magas dozisu intenzitasmodulalt sugarterapia biztonsagossaganak vizsgalata. Modszer: A sugarkezeles szovődmenyeinek gyakorisagat metaanalizissel elemeztek. Eredmenyek: Magasabb dozisu intenzitasmodulalt sugarterapiaval sem a sulyos urogenitalis (akut: p = 0,9, kesői: p = 0,95), sem a mersekelt vagy sulyos gastrointestinalis (akut: N/A, kesői: p = 0,08) mellekhatasokban nincs elteres a hagyomanyos besugarzasi eljarasokhoz kepest. A mersekelt akut (relativ kockazat = 1,39, 95%-os konfidenciaintervallum: 1,09–1,78, p = 0,008) es kesői (relativ kockazat = 1,48, 95%-os konfidenciaintervallum: 1,26–1,75, p<0,00001) urogenitalis mellekhatasok relativ kockazata magasabb. A hipofrakcionalt besugarzas sulyos urogenitalis (akut: N/A, kesői: p = 0,73) es mersekelt vagy sulyos gastrointestinalis ...

Stereotactic radiosurgery of abdominal cancer metastases. Report on the first successful extracranial radiosurgical intervention in Hungary

Absztrakt Az elmult evtizedekben a daganatgyogyitas fejlődesenek es eredmenyessegenek jelekent a lokalis terapias modalitasok szerepe az attetes betegsegek ellatasa soran felertekelődott. A szerzők tudomasa szerint a hazankban első eredmenyes, koponyan kivuli sugarsebeszeti beavatkozast ismertetik. Az 58 eves ferfi gyomoradenocarcinoma miatt műteten, kemoterapian es mellekveseattetek miatt metastatectomian esett at. Az első műtet utan 4 evvel a kovetesi komputertomografias vizsgalat ketgocu es inoperabilisnak velemenyezett peritonealis attetkepződest mutatott, a majszel, illetve a bal vese alatt, 2 cm-es atmerőkkel. Definitiv ellataskent, egy ulesben 12 Gy dozisu stereotaxias hasi sugarsebeszeti beavatkozast vegeztek, cone-beam komputertomografias ellenőrzes mellett, dinamikus ivbesugarzast, illetve 2-2 ivet alkalmazva. A kezeles 25 percig tartott, sem akut, sem kesői mellekhatast nem eszleltek. A kezeles utan 3, illetve 7 honappal elvegzett kontroll-komputertomografia teljes tumorregressziot igazolt. A s...Due to the development and increasing effectiveness of novel cancer therapies, the role of local treatments in metastatic diseases have been increasing in the last decades. The aim of the authors was to present the first successful extracranial stereotactic radiosurgical intervention in Hungary. A 58-year-old male patient with gastric adenocarcinoma underwent surgery and adjuvant chemotherapy. Later, surgical removal of suprarenal gland metastases and first line chemotherapy were carried out. Four years after the first surgery a follow up computed tomographic scan revealed bifocal peritoneal metastases caudally from the edge of the liver and the left kidney with diameters of 2 cm in size. Definitive stereotactic body radiosurgery of 12 Gy single dose was performed using cone beam computed tomography image guidance and intensity modulated arc therapy with two pairs of arcs. The total duration of the procedure was only 25 min and early or late side effects were not observed. Follow up computed tomography scans performed 3 and 7 months after the intervention showed complete regression of the metastases. The authors conclude that stereotactic body radiosurgery can be a safe and effective alternative of metastasis surgery in case of slow growing oligo-metastases.

Hasüregi daganatáttétek stereotaxiás sugárkezelése egy ülésben. Beszámoló az első hazai, koponyán kívüli sugársebészeti beavatkozásról

Absztrakt Az elmult evtizedekben a daganatgyogyitas fejlődesenek es eredmenyessegenek jelekent a lokalis terapias modalitasok szerepe az attetes betegsegek ellatasa soran felertekelődott. A szerzők tudomasa szerint a hazankban első eredmenyes, koponyan kivuli sugarsebeszeti beavatkozast ismertetik. Az 58 eves ferfi gyomoradenocarcinoma miatt műteten, kemoterapian es mellekveseattetek miatt metastatectomian esett at. Az első műtet utan 4 evvel a kovetesi komputertomografias vizsgalat ketgocu es inoperabilisnak velemenyezett peritonealis attetkepződest mutatott, a majszel, illetve a bal vese alatt, 2 cm-es atmerőkkel. Definitiv ellataskent, egy ulesben 12 Gy dozisu stereotaxias hasi sugarsebeszeti beavatkozast vegeztek, cone-beam komputertomografias ellenőrzes mellett, dinamikus ivbesugarzast, illetve 2-2 ivet alkalmazva. A kezeles 25 percig tartott, sem akut, sem kesői mellekhatast nem eszleltek. A kezeles utan 3, illetve 7 honappal elvegzett kontroll-komputertomografia teljes tumorregressziot igazolt. A s...Due to the development and increasing effectiveness of novel cancer therapies, the role of local treatments in metastatic diseases have been increasing in the last decades. The aim of the authors was to present the first successful extracranial stereotactic radiosurgical intervention in Hungary. A 58-year-old male patient with gastric adenocarcinoma underwent surgery and adjuvant chemotherapy. Later, surgical removal of suprarenal gland metastases and first line chemotherapy were carried out. Four years after the first surgery a follow up computed tomographic scan revealed bifocal peritoneal metastases caudally from the edge of the liver and the left kidney with diameters of 2 cm in size. Definitive stereotactic body radiosurgery of 12 Gy single dose was performed using cone beam computed tomography image guidance and intensity modulated arc therapy with two pairs of arcs. The total duration of the procedure was only 25 min and early or late side effects were not observed. Follow up computed tomography scans performed 3 and 7 months after the intervention showed complete regression of the metastases. The authors conclude that stereotactic body radiosurgery can be a safe and effective alternative of metastasis surgery in case of slow growing oligo-metastases.

A teljesítményvolumen-korlát hatása a Pécsi Tudományegyetem Klinikai Központ intézményi finanszírozására@@@Effects of performance-volume limit on the institutional financing of the Clinical Centre of the University of Pécs, Hungary

UNLABELLED The aim of our study is to demonstrate the effects of performance-volume limit (PVL) on the institutional financing of the Clinical Centre of the University of Pécs (CC UP). DATA AND METHODS The data involved in the analysis are based on the reports towards the National Health Insurance Fund Administration (NHIFA), concerning the active inpatient care by specialist in the period between 2004 and 2008. We determined the real NHIFA reimbursement per weighted case number and the financial loss caused by the PVL. We analyzed the proportion of local health care obligation and urgency cases in comparison of various clinics. RESULTS The reimbursement per weighted case number of CC UP has been less than the pre-announced NHIFA amounts after the installation of PVL. During the examined 5 years, i.e. 2004-2008, the loss in case of CC UP has been up to 3.256 million HUF due to the PVL. Concerning the whole of CC UP it means that 25.3 % of the treated cases and 24.5 % of the executed weighted case number has been out of local health care obligation. Studying the ratio of urgency cases inside the total volume of medical attendance, it is represented that 31.5 % of the cases and 36.1 % of the weighted case numbers came from the treatment of urgency cases. CONCLUSION The introduction of performance-volume limit considerably reduced the health insurance financing of CC UP between 2004 and 2008.

Effects of performance-volume limit on the institutional financing of the Clinical Centre of the University of Pécs, Hungary

UNLABELLED The aim of our study is to demonstrate the effects of performance-volume limit (PVL) on the institutional financing of the Clinical Centre of the University of Pécs (CC UP). DATA AND METHODS The data involved in the analysis are based on the reports towards the National Health Insurance Fund Administration (NHIFA), concerning the active inpatient care by specialist in the period between 2004 and 2008. We determined the real NHIFA reimbursement per weighted case number and the financial loss caused by the PVL. We analyzed the proportion of local health care obligation and urgency cases in comparison of various clinics. RESULTS The reimbursement per weighted case number of CC UP has been less than the pre-announced NHIFA amounts after the installation of PVL. During the examined 5 years, i.e. 2004-2008, the loss in case of CC UP has been up to 3.256 million HUF due to the PVL. Concerning the whole of CC UP it means that 25.3 % of the treated cases and 24.5 % of the executed weighted case number has been out of local health care obligation. Studying the ratio of urgency cases inside the total volume of medical attendance, it is represented that 31.5 % of the cases and 36.1 % of the weighted case numbers came from the treatment of urgency cases. CONCLUSION The introduction of performance-volume limit considerably reduced the health insurance financing of CC UP between 2004 and 2008.