Purpose: Rapid modeling, simulation, and optimization of resource allocation to an annual cohort of incident cancer patients, considering all clinically relevant chemotherapy choices to achieve the maximum overall survival in life years gained (LYG), for patients in each cancer site and stage.
Method: Orpheus is a software tool that uses operations research techniques (linear programming) to optimize the selection of health care resources by maximizing the total LYG, for a cohort of new cancer patients who are candidates for chemotherapy. Data from the Cancer Care Ontario program for evidence based care are the number of new patients with each cancer (e.g., colon, lung, and breast), and the overall survival (OS) for each alternative chemotherapy regimen, drug costs, staff requirements for treatment delivery, and costs per patient per year. Additional data from the literature regarding specific clinical trials are expected survival in life months and incremental survival benefits between drug regimens for each cancer site and stage.
Results: The total cohort is 7,800 colon, 7,000 lung, and 8,100 breast patients in Ontario based on 2007 incidence data. The cohort includes both adjuvant and metastatic patients. The increase in costs is disproportionate to the increase in benefits. Changes in human resources availability such as full-time equivalent (FTE) Oncologists, Nurses, Pharmacists, Daily Clinic chairs (DCC)) and number of beds, affect drug selection, other resource requirements, and outcomes. In order to treat all patients, the minimum mix of resources required is: Drug Budget $51M ($ CDN), 57 FTE Oncologists, 79 FTE Nurses, 33 FTE Pharmacists, 95 DCC, for a total cost of $135 M. This achieves a benefit of 34,464 LYG, 82.5% of the maximum possible OS. Alternatively, in order to achieve 100% of the maximum possible OS benefit (41,778 LYG), the following mix of resources is required: Drug Budget: $672 M, FTE Oncologists: 57 FTE Oncologists, 113 FTE Nurses, 61 FTE Pharmacists, 299 DCC, for a total cost of $856 M. The incremental benefit is 7,314 LYG; incremental cost per LYG is $98,578, and increase in total cost is $721 M. Marginal benefits decline as funding level increases, showing diminishing returns to additional resources.
Conclusion: The results have strong implications for policy makers and health service researchers interested in the best use of health care resources.
Candidate for the Lee B. Lusted Student Prize Competition