Terrence Sullivan

Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries: key messages from Disease Control Priorities, 3rd edition

Investments in cancer control--prevention, detection, diagnosis, surgery, other treatment, and palliative care--are increasingly needed in low-income and particularly in middle-income countries, where most of the worlds cancer deaths occur without treatment or palliation. To help countries expand locally appropriate services, Cancer (the third volume of nine in Disease Control Priorities, 3rd edition) developed an essential package of potentially cost-effective measures for countries to consider and adapt. Interventions included in the package are: prevention of tobacco-related cancer and virus-related liver and cervical cancers; diagnosis and treatment of early breast cancer, cervical cancer, and selected childhood cancers; and widespread availability of palliative care, including opioids. These interventions would cost an additional US

Shifting clinical accountability and the pursuit of quality: Aligning clinical and administrative approaches

20 billion per year worldwide, constituting 3% of total public spending on health in low-income and middle-income countries. With implementation of an appropriately tailored package, most countries could substantially reduce suffering and premature death from cancer before 2030, with even greater improvements in later decades.

Real world costs and cost-effectiveness of Rituximab for diffuse large B-cell lymphoma patients: a population-based analysis

This paper presents a narrative review of the literature on clinical accountability, and draws particularly on Englands experience establishing “clinical governance” as a base to examine the establishment of a clinical accountability framework for cancer services in Ontario. The review suggests that clinical governance and accountability approaches that actively mesh clinical and administrative approaches at both system and local levels are more likely to be effective in improving quality of care.

Why equity in health and in access to health care are elusive: Insights from Canada and South Africa

BackgroundCurrent treatment of diffuse-large-B-cell lymphoma (DLBCL) includes rituximab, an expensive drug, combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy. Economic models have predicted rituximab plus CHOP (RCHOP) to be a cost-effective alternative to CHOP alone as first-line treatment of DLBCL, but it remains unclear what its real-world costs and cost-effectiveness are in routine clinical practice.MethodsWe performed a population-based retrospective cohort study from 1997 to 2007, using linked administrative databases in Ontario, Canada, to evaluate the costs and cost-effectiveness of RCHOP compared to CHOP alone. A historical control cohort (nu2009=u20091,099) with DLBCL who received CHOP before rituximab approval was hard-matched on age and treatment intensity and then propensity-score matched on sex, comorbidity, and histology to 1,099 RCHOP patients. All costs and outcomes were adjusted for censoring using the inverse probability weighting method. The main outcome measure was incremental cost per life-year gained (LYG).ResultsRituximab was associated with a life expectancy increase of 3.2xa0months over 5xa0years at an additional cost of

Goals are Not Enough: Building Public Sector Capacity for Chronic Disease Prevention

16,298, corresponding to an incremental cost-effectiveness ratio of

Inching towards Accountability for Quality: Early Days for the Excellent Care for All Act:

61,984 (95% CI

Building the Ontario Surgical Oncology Program

34,087‒

La transition de la responsabilisation clinique et de la poursuite de la qualité : Harmoniser les démarches cliniques et administratives

135,890) per LYG. The probability of being cost-effective was 90% if the willingness-to-pay threshold was

Barriers to patient involvement in health service planning and evaluation: an exploratory study.

100,000/LYG. The cost-effectiveness ratio was most favourable for patients less than 60xa0years old (

Development of a set of strategy-based system-level cancer care performance indicators in Ontario, Canada

31,800/LYG) but increased to