https://observatorio.fm.usp.br/handle/OPI/21989
Title: | Integrated care pathway for rectal cancer treatment: health care resource utilization, costs, and outcomes |
Authors: | KOBAYASHI, Silvia T.; DIZ, Maria D. P. E.; CAMPOLINA, Alessandro G.; SOAREZ, Patricia C. De; RIBEIRO JR., Ulysses; NAHAS, Sergio C.; VASCONCELOS, Karina G. M. C.; CAPARELI, Fernanda; CECCONELLO, Ivan; HOFF, Paulo M. |
Citation: | INTERNATIONAL JOURNAL OF EVIDENCE-BASED HEALTHCARE, v.15, n.2, p.53-62, 2017 |
Abstract: | Aim: Managed Flow C20 (MFC20) is an integrated care pathway (ICP) for rectal cancer implemented at a public teaching hospital. This study aims to quantify resource utilization and estimate direct costs and outcomes associated with the use of this ICP. Methods: We evaluated consecutive rectal cancer patients treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery, comparing the period before the ICP implementation (Pre-MFC20 group) and after (MFC20 group). We assessed times between treatment steps and quantified the resources utilized, as well as their costs. Results: There were 112 patients in the Pre-MFC20 group and 218 in the MFC20 group. The mean treatment intervals were significantly shorter in the MFC20 group-from the first medical consultation to nCRT (48.3 vs. 87.5 days; P< 0.001); and from nCRT to surgery (14.8 vs. 23.0 weeks; P< 0.001) -as was the mean total treatment time (192.0 vs. 290.2 days; P< 0.001). Oncology consultations, computed tomography, MRI, and radiotherapy sessions were utilized more frequently in the Pre-MFC20 group (P< 0.001). The median per-patient cost was US$ 11 180.92 in the Pre-MFC20 group, compared with US$ 10 412.88 in the MFC20 group (P = 0.125). Daily hospital charges and consultations were the major determinants of the total cost of the treatment. There was no statistical difference in overall survival in the time periods examined. Conclusion: : Implementation of a rectal cancer ICP reduced all treatment intervals and promoted rational utilization of oncology consultations and imaging, without increment in per-patient costs or detrimental effects in overall survival. |
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