Jan Norum

Telemedicine in haemodialysis : a university department and two remote satellites linked together as one common workplace

A common workplace was established between the renal unit at the University Hospital of North Norway and two satellite dialysis centres, in Alta and Hammerfest. A 2 Mbit/s ATM network was employed for IP-based videoconferencing. A common electronic medical record system and dialysis monitoring software were used. During an eight-month study period, nine patients were enrolled and 225 videoconferences were performed for daily visits and regular rounds. A bandwidth of 768 kbit/s was required for satisfactory teledialysis. Although technical (28%) and logistical problems (10%) were frequent, five hospitalizations and one-third of the planned visiting rounds were avoided. An economic analysis showed that annual savings amounted to US

Treatment costs in hodgkin's disease: A cost-utility analysis

46,613, while annual costs were US

Trastuzumab in adjuvant breast cancer therapy. A model based cost-effectiveness analysis

79,489. Despite the technical difficulties in about 30% of conferences, the nurses were satisfied with the videoconferencing system. Digital X-rays were communicated without problems. The pilot study indicates that satellite units may be incorporated into the daily management at the central institution by telemedicine.

Information and communication technology (ICT) in oncology. Patients' and relatives' experiences and suggestions

The aim of this study was to estimate costs of treatment for Hodgkins disease (HD) and the outcome in health in terms of quality-adjusted life-years (QALYs), and compare these to a constructed nontreatment alternative. All 55 patients treated for HD at the oncological unit of the University Hospital of Tromsø between 1985 and 1993 were included. The total treatment costs (medication, hospital stay, hospital hotel stay, radiotherapy, travelling, loss in production, i.e. work) were retrospectively estimated for all patients. In December 1994, the 49 survivors were sent a EuroQol questionnaire recording quality of life: 42 responded. The mean quality of life score was 0.78 on a 0-1 scale, and the mean total cost of treatment was pounds 12512. The total treatment costs were significantly higher in patients with advanced clinical stages of the disease (P = 0.0006), B-symptoms (fever, sweats, weight loss) (P = 0.0027) and relapse (P < 0.0001). The costs of one QALY (with production gains included and using a 10% discount rate) were estimated at pounds 1651. When excluding production gains and using a 5% discount rate, the figures became pounds 1327. This makes HD one of the most cost-effective malignancies to treat.

Lumpectomy or mastectomy? Is breast conserving surgery too expensive?

Trastuzumab has shown activity in early breast cancer patients that overexpress HER2. Significant resources have to be allocated to finance this therapy, underlining the need for cost-effectiveness analysis. A model was set up, societal costs were calculated and the discount rate was 3%. Life expectancy data were based on the literature and prolonged according to qualified guess (10% and 20% absolute improvement in overall survival (OS)). The comparator was the FEC100 regimen. The median additional health care cost per patient treated was €33 597. The yielding cost per life year gained (LYG) was €15 341 with a 20% improved OS and €35 947 with 10% improved OS. The corresponding net health care cost per quality adjusted life year (QALY) was €19 176 and €44 934. Including all resource use the figures were €8148 and €30 290 per LYG. Sensitivity analyses documented survival gain, price of trastuzumab, production gain and discount rate to be the major factors influencing cost-effectiveness ratio. Trastuzumab is indicated cost effective in Norway.

Cost-effectiveness and quality of life in surgeon versus general practitioner-organised colon cancer surveillance: a randomised controlled trial

Cancer patients and relatives worldwide are turning more and more to the internet to obtain health information. The goal of this survey was to clarify their experiences and suggestions on the implementation of information and communication technology (ICT) in oncology. A total of 127 patients and 60 relatives visiting the outpatient clinic at the Department of Oncology, University of North Norway (UNN), the regional office of the Norwegian Cancer Union (NCU) and the Montebello Centre were included in a questionnaire-based study. Participants were recruited during the period September 2001 to February 2002. There were 92 women and 95 men. We revealed that hospital doctors, followed by nurses and friends, were the most important informants. Two-thirds of patients and relatives had access to the internet, but fewer than one-third had searched the internet for medical information and only one-fifth had discussed information accessed with their doctor. Only one-tenth had visited a hospital website. Internet access was correlated with young age. Almost two-thirds suggested that e-mail and/or WAP (wireless application protocol) communication should be included in hospital–patient communication. Concerning hospital websites, waiting time, treatment offer and addresses were considered the top three topics of interest. In conclusion, the majority of cancer patients and relatives have access to the internet. They recommend ICT employed in patient–hospital communication and suggest waiting time, treatment offers and addresses the three most important topics on hospital websites.

Lessons learned from the intrinsic subtypes of breast cancer in the quest for precision therapy

In the last decade, breast cancer patients have enjoyed an increase inbreast conserving surgery (BCS). At present, modified radical mastectomy(MRM) and BCS offers equal expectations of survival. During the last fewyears, however, a drop in the frequency of BCS has been reported by severalauthors. Is this new trend due to economic concerns? To clarify the costs ofbreast cancer therapy (stage I and II), we review the literature and includea cost-utility and a cost-minimisation analysis comparing MRM and BCS.The treatment cost (per patient) of BCS and MRM in Norway was calculated at

A randomised phase II multicentre trial of irinotecan (CPT-11) using four different schedules in patients with metastatic colorectal cancer

9,564 and

Prioritisation of telemedicine services for large scale implementation in Norway

5,596, respectively. Employing a quality of lifegain in BCS of 0.03 (0–1 scale) and a 5% discount rate, thecost per QALY in BCS compared to MRM was

Telemedicine in radiotherapy: a study exploring remote treatment planning, supervision and economics.

20,508. In cost-minimisinganalysis, BCS and mastectomy followed by reconstructive surgery had a costof