Hutchinson Institute for Cancer Outcomes Research
Bankruptcy may represent a unique and heretofore unstudied potential source of health disparity. In this study, we formed a novel partnership with the Federal Bankruptcy Court and the National Cancer Institute’s SEER cancer registry to link bankruptcy records for cancer patients and a matched control population without cancer.
Our findings indicated that cancer patients experience excess rates of bankruptcy compared to persons without cancer, results that have potentially important implications for those researching the causes of cancer disparity, and for policymakers seeking to mitigate the economic as well as clinical burden of persons with cancer.
The BMT CTN 1101 parent trial is a Phase III, randomized, open label, multicenter, prospective, comparative trial of double unrelated umbilical cord blood (dUCB) versus HLA-Haploidentical related bone marrow (haplo-BM) transplantation after reduced intensity conditioning (RIC) in patients with hematologic malignancies. This clinical trial is being led by Dr. Paul O’Donnell at Seattle Cancer Care Alliance. In conjunction with this clinical trial, Dr. Scott Ramsey is spearheading a parallel cost-effectiveness analysis substudy to determine the incremental cost per quality adjusted life years (QALYs), of double unrelated umbilical cord blood (dUCB) versus HLA-Haploidentical related bone marrow (haplo-BM).
The purpose of this ancillary cost-effectiveness analysis substudy is to compare patient outcomes to determine which transplantation source improves quality-adjusted survival and whether the more effective transplant type also provides a cost savings to the health care payer. BMT CTN 1101 is one of the first trials to study the total cost of transplantation by collecting out-of-pocket costs from patients and caregivers. The results of this cost-effectiveness substudy will have the potential to fundamentally change treatment decision-making for patients by maximizing health outcomes for patients and helping patients and health insurers to manage high transplantation costs.
This collaboration between GE Healthcare, Arizona State University’s Center for Sustainable Health, and Fred Hutch uses multi-stakeholder engagement, and early cycle health economic evaluation to identify, prioritize and evaluate the diagnostic technologies early in the research and development process. The aim of this collaborative project is use a systems-based, stakeholder-guided approach to develop cost-effective, evidence-based diagnostics that improve human health and are well-positioned for clinical implementation.
The ADVICE project, performed with active involvement of local stakeholders, developed a data infrastructure for comparative effectiveness research studies that linked private and public insurance claims data with the SEER Cancer Registry. Initial analyses focused on MRI, PET/PET-CT and CT compared to mammography for women with local, regional and advanced stage breast cancer as well as the use of PET/PET-CT for staging of newly diagnosed NSCLC patients. The resulting dataset consists of more than 85% of patients in the public and private insurance market (excluding the self-insured) in Western Washington. The size and inclusiveness of this database allows for results to be generalized to other regions and nationally.
This research initiative aims to understand the impact of bevacizumab use in overall survival for patients diagnosed with metastatic colorectal cancer using SEER-Medicare claims data. In collaboration with Genentech, Inc., this retrospective database study is led by Dr. Shankaran, gastrointestinal oncologist at Seattle Cancer Care Alliance and clinical investigator at the Fred Hutch. Bevacizumab is a monoclonal antibody drug marketed by Genentech, Inc. that has become an essential component of colorectal cancer therapy in the last several years. Although the use of bevacizumab in combination with chemotherapy for the first-line treatment of metastatic colorectal cancer (mCRC) has been shown to improve overall survival in large clinical trials, the impact of bevacizumab on patient survival in community practices in the United States is not known.
To address the uncertainties associated with low-dose CT (LDCT) screening for lung cancer, Dr. Goulart and collaborators at the Hutchinson Institute for Cancer Outcomes Research (HICOR) have developed a pilot registry of patients undergoing LDCT screening at the Seattle Cancer Care Alliance (SCCA). This single center pilot study conducts chart reviews and patient surveys using the EQ-5-D and SF-12 quality of life questionnaires to collect prospective data on LDCT test performance (true and false positive rates), health-related quality of life at baseline, 3, and 6 months after screening, healthcare resource utilization, medical complications, adherence to guidelines for patient selection, and smoking cessation rates. This pilot project has been critical for establishing the research infrastructure for data collection in a single academic medical center and will generate insightful preliminary data about the characteristics of the initial patients screened in practice and the clinical and economic outcomes of LDCT screening after the release of the NLST results.