Economic Evaluation of Sarcoma Patients Management in France

NCT ID: NCT05272358

Last Updated: 2022-03-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

2431 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-02-08

Study Completion Date

2024-02-08

Brief Summary

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The aim of this project is to (1) evaluate the efficiency of early management of sarcoma patients by the sarcoma referral network (NETSARC) vs. outside the network; (2) measure the budgetary impact of the generalization of the most cost-effective strategy across the country; (3) identify the organizational and financial constraints likely to hinder the generalization of the most cost-effective strategy and propose solutions, and finally (4) analyse the budgetary impact of a generalization of sarcoma patient care by the reference network by integrating the organizational and financial solutions proposed.

The study relies on an exhaustive national cohort of all sarcoma patients who underwent primary tumor surgery for the year 2013. Patients will be allocated to four distinct strategies, each representing a different management of sarcoma patients who had a sarcoma-specialized multidisciplinary tumor board (MDTB) before the initial surgery and complete initial management in the network (strategy 1); patients who had a sarcoma-specialized MDTB before the initial surgery and initial management outside the network (strategy 2); patients who had a sarcoma-specialized MDTB after initial surgery and initial management outside the network (strategy 3); patients who had an initial management outside the network, without sarcoma-specialized MDTB neither before nor after the initial surgery (strategy 4).

Matching of the National Health Data System (SNDS) and the NETSARC databases made it possible to include 2431 patients in the study. These databases will allow to obtain information on patients, estimate overall survival and identify healthcare consumption, which will be useful in achieving study's objectives.

Detailed Description

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Introduction

Sarcomas are a large family of rare and heterogeneous tumors. As a consequence, their diagnosis and management are difficult and complex, which can lead to misdiagnosis and suboptimal patient management. Thus, in 2009, the National Cancer Institute (INCa) and the "Direction Générale de l'Offre de Soins" (DGOS) supported the creation of a sarcoma reference network (NETSARC) with the aim to guarantee optimal care for sarcoma patients. Numerous studies show that initial patients' management in the sarcoma referral network reduces the risk of death and relapse. However, the proportion of sarcoma patients initially managed within the referral network is still too low today. The aim of this project is to (1) evaluate the efficiency of early management of sarcoma patients by the sarcoma referral network vs. outside the network; (2) measure the budgetary impact of the generalization of the most cost-effective strategy across the country; (3) identify the organizational and financial constraints likely to hinder the generalization of the most cost-effective strategy and propose solutions, and finally (4) analyses the budgetary impact of a generalization of sarcoma patient care by the reference network by integrating the organizational and financial solutions proposed.

Methods and analysis

The study relies on an exhaustive national cohort of all sarcoma patients (ICD code 10 C49, C48 or C40-41) who underwent primary tumor surgery for the year 2013. Patients will be allocated to four distinct strategies, each representing a different management of sarcoma patients: patients who had a sarcoma-specialized multidisciplinary tumor board (MDTB) before the initial surgery and complete initial management in the network (strategy 1); patients who had a sarcoma-specialized MDTB before the initial surgery and initial management outside the network (strategy 2); patients who had a sarcoma-specialized MDTB after initial surgery and initial management outside the network (strategy 3); patients who had an initial management outside the network, without sarcoma-specialized MDTB neither before nor after the initial surgery (strategy 4).

Matching of the National Health Data System (SNDS) and the NETSARC databases made it possible to include 2431 patients in the study. These databases will allow to obtain information on patients, estimate overall survival and identify healthcare consumption, which will be useful to achieve study's objectives.

The evaluation of early management of operable sarcoma patients by the sarcoma reference network vs. outside the network will be based on three approaches which are both distinct and complementary in terms of decision support. (1) Firstly, an efficiency assessment based on a cost-effectiveness analysis (CEA) and a cost-utility analysis (CUA) will be carried out. The short-term CEA will use the Incremental Cost-Effectiveness Ratio (ICER) expressed as cost per life year gained, while the long-term CUA will use the ICER expressed as cost per quality-adjusted life year (QALY) gained. The efficiency analysis will be complemented by a Budget Impact Analysis (BIA) based on an estimate of the additional and avoided costs induced by the generalization of the most cost-effective strategy determined in the previous steps. (2) Next, an organizational evaluation focusing on a flow analysis will be carried out. (3) Finally, an innovative financing model will be developed to encourage inter-center cooperation.

Ethics and dissemination

The OPTISARC project will be conducted in accordance with the ethical principles of the latest version of the Declaration of Helsinki developed by the World Medical Association (WMA). This study falls within the framework of research not involving the human person, study or health assessment (RNIPH) and will be conducted in accordance with the French and European laws and regulations in force, as well as any other applicable guidelines.

This Project has obtained a favorable opinion from the "Comité d'Expertise pour les Recherches, les Etudes et les Evaluations dans le domaine de la Santé" (CEREES) and an authorization from the "Comité National Informatique et Liberté" (CNIL) allowing the access to SNDS data (DCIR and PMSI) from 2013 to 2018.

Conditions

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Sarcoma

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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strategy 1: sarcoma MDTB before surgery and initial management in the NETSARC network

Patients who had a sarcoma-specialized multidisciplinary tumour board (MDTB) before the initial surgery and complete initial management (including surgery) in the network (also including patients who had a sarcoma-specialized MDTB after the initial surgery and complete initial management in the network) (strategy 1)

NETSARC network

Intervention Type OTHER

MDTB and/or surgery in NETSARC network

strategy 2: sarcoma MDTB before surgery and initial management outside the NETSARC network

Patients who had a sarcoma-specialized MDTB before the initial surgery and initial management (including surgery) outside the network (strategy 2)

NETSARC network

Intervention Type OTHER

MDTB and/or surgery in NETSARC network

strategy 3: sarcoma MDTB after surgery and initial management outside the NETSARC network

Patients who had initial management (including surgery) outside the network and a sarcoma-specialized MDTB after initial surgery (strategy 3)

NETSARC network

Intervention Type OTHER

MDTB and/or surgery in NETSARC network

strategy 4: No sarcoma MDTB and initial management outside the NETSARC network

Patients who had an initial management (including surgery) outside the network, without sarcoma-specialized MDTB neither before nor after the initial surgery (strategy 4).

No interventions assigned to this group

Interventions

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NETSARC network

MDTB and/or surgery in NETSARC network

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Sarcoma diagnosis between 01/01/2013 and 31/12/2013
* International Classification of Diseases (ICD) code 10: C49 Malignant neoplasm of other connective and soft tissue, or C48 Malignant neoplasm of retroperitoneum and peritoneum, or C40-41 Malignant neoplasm of bone and articular cartilage of limbs)
* Surgery of the primary tumour.

Exclusion Criteria

* Gastro intestinal stromal tumour
* Diagnosis not confirmed by the a second histological review
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Saint Etienne School of Mine

OTHER

Sponsor Role collaborator

Rennes University Hospital

OTHER

Sponsor Role collaborator

Assistance Publique - Hôpitaux de Paris

OTHER

Sponsor Role collaborator

Centre Leon Berard

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jean-Yves Blay, PU-PH

Role: PRINCIPAL_INVESTIGATOR

Centre Leon Berard

Locations

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CHU Jean Minjoz

Besançon, , France

Site Status RECRUITING

Institut Bergonié

Bordeaux, , France

Site Status RECRUITING

Centre François Baclesse

Caen, , France

Site Status RECRUITING

Centre Jean Perrin

Clermont-Ferrand, , France

Site Status RECRUITING

Centre Georges François Leclerc

Dijon, , France

Site Status RECRUITING

CHU Saint-Pierre

La Réunion, , France

Site Status RECRUITING

Centre Oscar Lambret

Lille, , France

Site Status RECRUITING

CHU Dupuytren

Limoges, , France

Site Status RECRUITING

Centre Leon Berard

Lyon, , France

Site Status RECRUITING

CHU Timone

Marseille, , France

Site Status RECRUITING

Institut Paoli Calmettes

Marseille, , France

Site Status RECRUITING

ICM Val d'Aurelle

Montpellier, , France

Site Status RECRUITING

Institut de cancérologie de Lorraine

Nancy, , France

Site Status RECRUITING

Institut de Cancérologie de l'Ouest

Nantes, , France

Site Status RECRUITING

Centre Antoine Lacassagne

Nice, , France

Site Status RECRUITING

CHU Cochin

Paris, , France

Site Status RECRUITING

CHU Saint-Louis

Paris, , France

Site Status RECRUITING

Institut Curie

Paris, , France

Site Status RECRUITING

Institut jean Godinot

Reims, , France

Site Status RECRUITING

CHU Pontchaillou

Rennes, , France

Site Status RECRUITING

Centre Henri Becquerel

Rouen, , France

Site Status RECRUITING

Institut de Cancérologie CHU Hautepierre

Strasbourg, , France

Site Status RECRUITING

IUCT Institut Claudius Régaud

Toulouse, , France

Site Status RECRUITING

CHU Trousseau

Tours, , France

Site Status RECRUITING

Gustave Roussy

Villejuif, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Lionel Perrier, PhD

Role: CONTACT

+33 478782908

Facility Contacts

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Loic Chaigneau, MD

Role: primary

Antoine Italiano, PU-PH

Role: primary

Sharmini Varatharajah, MD

Role: primary

Pascale Dubray-Longeras, MD

Role: primary

Sylvain Causeret, MD

Role: primary

Jean-Christophe Ruzic, MD

Role: primary

Nicolas PENEL, PU-PH

Role: primary

Fabrice Fiorenza, MD

Role: primary

Jean-Yves Blay, PU-PH

Role: primary

Florence Duffaud, PU-PH

Role: primary

François Bertucci, PU-PH

Role: primary

Sébastien Carrère, MD

Role: primary

Maria Rios, MD

Role: primary

Emmanuelle Bompas, MD

Role: primary

Esma Saada, MD

Role: primary

Philippe Anract, PU-PH

Role: primary

Céleste Lebbé, PU-PH

Role: primary

Sophie Piperno-Neumann, MD

Role: primary

Pauline Soibinet-Oudot, MD

Role: primary

Mickael Ropars, PU-PH

Role: primary

Cécile Guillemet, MD

Role: primary

Jean-Emmanuel Kurtz, PU-PH

Role: primary

Christine Chevreau, MD

Role: primary

Philippe Rosset, PU-PH

Role: primary

Axel Le Cesne, Prof.

Role: primary

Other Identifiers

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OPTISARC

Identifier Type: -

Identifier Source: org_study_id

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