Abstract

Objective: To estimate the relationship between medical expenditures and compliance to clinical practice guidelines (CPG) for the initial treatment of patients with sarcoma. Methods: We examined selected cohorts of patients diagnosed with sarcoma in 2005 and 2006, and treated at the University hospital and/or the cancer centre of the Rhône-Alpes region, France (n=90). The main outcome measurements were: patient characteristics, compliance with CPG, health outcomes, and costs. Data were mainly extracted from patient records. The logarithm of treatment costs was modelled using linear and Tobit regressions. Results: Rates of compliance with CPG were 86%, 66%, 88%, 89%, and 95% for initial diagnosis, primary surgical excision, wide surgical excision, chemotherapy, and radiotherapy, respectively. Total average costs reached €24,439, with €1,784, €11,225, €10,360, and €1,016 for diagnosis, surgery (primary and wide surgical excisions), chemotherapy, and radiotherapy, respectively. Compliance of diagnosis with CPG decreased the cost of diagnosis, whereas compliance of primary surgical excision increased the cost of chemotherapy. Compliance of chemotherapy with CPG decreased the cost of radiotherapy. Conclusion: Since chemotherapy is one of the major cost drivers, these results support that, for patients with these rare tumours, compliance with guidelines increases medical care expenditures in the short term.

Key-words:

Cost, Clinical guidelines, Medical practices, Oncology, Sarcoma.