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3 results on '"Eugena Stamuli"'

1. Treatment pathways and associated costs of metastatic colorectal cancer in Greece

Author

Ioannis Sougklakos, Elias Athanasiadis, Ioannis Boukovinas, Michalis Karamouzis, Aggelos Koutras, Paulos Papakotoulas, Dimitra Latsou, Magda Hatzikou, Eugena Stamuli, Athanasios Balasopoulos, and Aggelos Sideris

Subjects
Metastatic colorectal cancer, Braf600 mutation, Disease burden, Treatment pathways, Costs, Greece, Medicine (General), R5-920
Abstract

Abstract Objectives Colorectal cancer (CRC) is the second leading cause of cancer in Europe, with 1.931.590 people newly diagnosed in 2020. The purpose of this study is the investigation of treatment options and healthcare resource metastatic CRC (mCRC) in Greece. Methods This study is based on the information collected in November 2020 by an expert panel comprising of 6 medical oncologists from major public and private centers around Greece. A 3-round survey was undertaken, according to Delphi method. The treatment phases studied were: pre-progression; disease progression and terminal care. Pharmaceutical costs and resource utilization data were considered from the perspective of the Greek National Services Organization (EOPYY). RESULTS: Experts agreed that the anticipated prevalence of RAS mutation in mCRC is 47% (30% RAS/BRAF WT Left, 17% RAS/BRAF WT Right); 8% BRAF while, MSI-H/dMMR are found in 5% of mCRC tumors. Based on mutational status, 74.8% of patients receive biological targeted therapies in combination with fluoropyrimidine/based combination chemotherapy, as 1st line treatment, and 25.2% combination chemotherapy alone. At 2nd line, 58.6% of patients receive biological targeted therapies in combination with chemotherapy, 25.4% immunotherapy, 11% combination chemotherapy and 5% biological targeted therapies. At 3rd line 56% of patients receive combination chemotherapy, 28% biological targeted therapies, 10% biological targeted therapies in combination with chemotherapy and 6% immunotherapy. The weighted annual cost (pharmaceuticals and resource use cost) in 1st line per mCRC patient was calculated at €28,407, in 2nd line €33,568, in 3rd line €25,550. The annual cost beyond 3rd line per patient regardless mutation was €19,501 per mCRC patient. Conclusions mCRC is a societal challenge for healthcare systems as the treatment is more prolonged but expand patients’ survival. Thus, reimbursement decisions should be based not just on the cost of the treatment, but on the magnitude of the benefit of its treatment on patients’ survival and quality of life.

Published
2022
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2. Cost-effectiveness of acupuncture for irritable bowel syndrome: findings from an economic evaluation conducted alongside a pragmatic randomised controlled trial in primary care

Author

Eugena Stamuli, Sally Brabyn, Tracy Stuardi, Helen Tilbrook, Hugh MacPherson, Karen Bloor, and David J. Torgerson

Subjects
Quality of life, medicine.medical_specialty, Cost effectiveness, Cost-Benefit Analysis, Acupuncture Therapy, Alternative medicine, Severity of Illness Index, law.invention, Quality of life (healthcare), Randomized controlled trial, law, Severity of illness, Confidence Intervals, medicine, Acupuncture, Humans, Health technology assessment, lcsh:RC799-869, health care economics and organizations, Irritable bowel syndrome, Primary Health Care, business.industry, Gastroenterology, Health Care Costs, General Medicine, medicine.disease, Combined Modality Therapy, United Kingdom, Economic evaluation, Quality-adjusted life year, Physical therapy, lcsh:Diseases of the digestive system. Gastroenterology, Quality-Adjusted Life Years, business, Research Article
Abstract

Background There is insufficient evidence to determine whether acupuncture is a cost-effective treatment for irritable bowel syndrome. The objective of this study is to assess the cost-effectiveness of acupuncture as an adjunct to usual care versus usual care alone for the treatment of Irritable Bowel Syndrome (IBS). Methods Cost-utility analysis conducted alongside a pragmatic, multicentre, randomised controlled trial. 233 patients with irritable bowel syndrome were randomly allocated to either acupuncture plus usual care, or usual care alone. Cost-effectiveness outcomes are expressed in terms of incremental cost per quality adjusted life year (QALY) at one year after randomisation. Costs were estimated from the UK National Health Service perspective for a time horizon of one year. Cost-utility ratios were estimated based on complete case analysis for the base case analysis, where only patients with available EQ-5D and cost data were included. Sensitivity analyses comprised a multiple imputation approach for missing data and a subgroup analysis for the more severe cases of IBS. Results The base case analysis showed acupuncture to be marginally more effective than usual care (gain of 0.0035 QALYs, 95% CI: -0.00395 to 0.0465) and more expensive (incremental cost of £218 per patient (95% CI: 55.87 to 492.87) resulting in an incremental cost-effectiveness ratio of approximately £62,500. Sensitivity analysis using multiple imputation for missing data resulted in acupuncture appearing less effective and more costly than usual care, so usual care is dominant. Subgroup analysis selecting the most severe cases of IBS (Symptom Severity Score of over 300) suggested that acupuncture may be a cost-effective treatment option for this group, with a cost-per-QALY of £6,500. Conclusions Acupuncture as an adjunct to usual care is not a cost-effective option for the whole IBS population; however it may be cost-effective for those with more severe irritable bowel syndrome. Trial registration Current Controlled Trials ISRCTN08827905

Published
2012

3. Acupuncture for irritable bowel syndrome: A protocol for a pragmatic randomised controlled trial

Author

Helen Tilbrook, Arthur R Kang’ombe, Tracey Stuardi, David J. Torgerson, Julie A Reynolds, Hugh MacPherson, Martin Bland, Karen Bloor, Peter J. Whorwell, David Geddes, Eugena Stamuli, and Helen Cox

Subjects
Male, medicine.medical_specialty, Cost effectiveness, Cost-Benefit Analysis, Population, Acupuncture Therapy, Severity of Illness Index, law.invention, Irritable Bowel Syndrome, Study Protocol, Quality of life, Randomized controlled trial, law, Health care, Severity of illness, Outcome Assessment, Health Care, Acupuncture, Medicine, Humans, lcsh:RC799-869, education, education.field_of_study, business.industry, Gastroenterology, Physicians, Family, General Medicine, Quality-adjusted life year, Treatment Outcome, Physical therapy, Quality of Life, Female, lcsh:Diseases of the digestive system. Gastroenterology, Quality-Adjusted Life Years, business
Abstract

Background There is insufficient evidence on the effectiveness of acupuncture for irritable bowel syndrome (IBS) for conclusions to be drawn. Given the current interest in acupuncture by patients, it is in the public interest to establish more rigorous evidence. Building on the positive findings from a pilot study, in this paper we present the protocol for a fully-powered trial designed to establish whether or not acupuncture is effective and cost-effective. Methods/Design In this pragmatic randomised controlled trial we will randomise patients recruited directly from GP databases to either 10 sessions of acupuncture plus usual GP care or to usual GP care alone. The primary clinical outcome will be the IBS Symptom Severity Score (SSS) (maximum score 500) at three months, and at 12 month assessing whether there is an overall benefit. We estimate the sample size required to detect a minimum clinical difference at 90% power and 5% significance to be 188 patients. To allow for loss to follow up we will recruit 220 patients drawn from an estimated primary care population of 140 000. Analysis will be by intention-to-treat, and multiple imputation is to be used for missing data. In a nested qualitative study using in-depth interviews, we will explore how patients, acupuncturists, and GPs explain and subsequently understand acupuncture to work. We will use purposive sampling to identify patients and flexible topic guides for the interviews. The data analysis will lead to a thematic description of how patients and practitioners explain how acupuncture works, and whether or not the explanations influence treatment outcome and/or referrals. We will undertake a cost-effectiveness analysis at 12 months by comparing resource use in the two groups with any treatment benefit. We will use the EQ-5D to measure health-related quality of life and convert into quality adjusted life years (QALYs). We will generate cost effectiveness acceptability curves (CEACs) exploring the probability that acupuncture will produce an acceptable cost per QALY at different cost-effectiveness thresholds. Discussion The trial has received NHS ethics approval and recruited 233 patients between November 2008 and June 2009. Results are expected in 2011. Trial Registration Current Controlled Trials ISRCTN08827905

Published
2010

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