Table A6:

Ljungman et al, 2012

Ljungman D, Hyltander A, Lundholm K. Cost-utility estimations of palliative care in patients with pancreatic adenocarcinoma: a retrospective analysis. World J Surg 2013;37:1883–91
Methods
Study details	Population	Interventions
Type of economic analysis: CUA Study design: Individual-patient-data CUA Perspective: Health care payer perspective Time horizon: 1, 2, 5 years for different patient groups	A population-based cohort of patients with exocrine pancreatic adenocarcinoma from 1998 to 2005 was evaluated retrospectively (n = 444) Mean age: 66–69 Male: Not reported	A subgroup of 34 patients with pancreatic adenocarcinoma who were treated with personalized palliative care (e.g., indomethacin and erythropoietin treatment, nutritional support, and insulin treatment with the goal of providing the best individual palliative care for each patient by accounting for their clinical characteristics) Patients who had more conventional treatment, mainly based on sufficient pain treatment, are referred to as the standard palliative care group (n = 271) Results were compared to similar findings in a previously reported group of patients with pancreatic carcinoma resected for cure (n = 31)
Approach to analysis
The evaluation parameters included survival, direct health care costs, and QALY estimates (that were based upon the SF-6D health utility). The study report describes in details patients and data retrieval, HRQOL, cost measures, and statistical analysis. Nonparametric Mann–Whitney and Kruskal–Wallis tests were used for comparisons between groups. Survival from the date of diagnosis (date of surgery for resection patients) was analyzed according to the Kaplan-Meier test and tested by log rank. QALY calculations were performed across 1 year
Results
Costs	Health outcomes	Cost-effectiveness
Currency and cost year: 2011 Euros CEA: The total health care costs were 50% on palliative care compared to costs for surgical R0 resections (€23,701 and €50,950, respectively) Discount rate: 5%	Primary outcome: QALYs for 1 year from diagnosis were 0.2 (95% CI 0.17–0.23) in patients on palliative care and 0.48 (95% CI 0.44–0.54) in resection patients	Primary ICER: Costs per QALY were €118,418 and €106,146 (95% CI €103,048 €139,418 and €94,352–€115,795) for the palliative care group and the resection group, respectively
Interpretation
Sensitivity analyses	Limitations and applicability
Not reported Treatment effectiveness: Patients on personalized palliative care showed significantly better survival than patients on standard palliative (without adjustment for baseline characteristics). Patients who underwent resection for cure showed better survival, as expected, compared to patients with unresectable tumours who experienced overall palliative care. Estimated QALYs over 1 year from diagnosis were 0.20 and 0.48 for palliation and resection patients, respectively (95% CI 0.17–0.23 and 0.44–0.54, respectively)	Retrospective analysis of patients with quite different prognoses. The choice of comparators (comparing palliative care patients with patients receiving curative treatment with a high chance of prolonged life) made the results hard to interpret. Because the study was conducted in Sweden, the results (including the limitations described here) may not be applicable to the Ontario setting Key assumptions: The 3 groups were comparable
Data Sources
Clinical effectiveness: A consecutive retrospective database of 444 consecutive patients diagnosed with malignancy of the exocrine pancreas or ampulla (ICD-7: 155.3 or 157) at Sahlgrenska University Hospital from 1998–2005. This database contains survival and SF-36 data
Costs: The cost registry provided costs per patient, including health care interventions such as surgery, intensive care, radiologic examinations, drugs, and laboratory analyses. It also contained the basic charge for admission including bed and standardized provision of care in wards and staff salaries
Quality of life: Most calculations in the study were based on the entire consecutive cohort of 444 patients from 1998–2005, whereas the HRQOL data for palliative care group were based on information from the subgroup of 21 patients on personalized palliative care with complete data and from 31 resection patients
Funding
This study was supported in part by grants from the Assar Gabrielsson Foundation (AB Volvo), the Gothenburg Medical Society, the Swedish Government (LUA-ALF), the Swedish Cancer Society, and the Swedish Research Council (08712)

Abbreviations: CEA, cost-effectiveness analysis; CI, confidence interval; CUA, cost-utility analysis; HRQOL, health-related quality of life; ICD-7, International Classification of Diseases, 7th edition; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year.