Use of Drugs in Clinical Practice and the Associated Cost of Cancer Treatment in Adult Patients with Solid Tumors: A 10-Year Retrospective Cohort Study

Round 1

Reviewer 1 Report

REVIEW REPORT FOR THE STUDY “USE OF DRUGS IN CLINICAL PRACTICE AND THE ASSOCIATED COST OF CANCER TREATMENT IN ADULT PATIENTS WITH SOLID TUMORS: A 10 YEAR REAL WORD EVIDENCE AMBISPECTIVE COHORT STUDY”

Journal: Current Oncology

The paper "Use of Drugs in Clinical Practice and the Associated Cost of Cancer Treatment in Adult Patients with Solid Tumors: A 10 Year Real Word Evidence Ambispective Cohort Study", performs a study on the experience of the use of drugs in real clinical practice and the associated cost for the treatment of solid tumors in adult patients attended at Vall d’Hebron University Hospital.

Title and summary. The title and abstract express well the object of study, objectives, and results of the article.

Structure of the article. The contents are well organized and they adhere to the IMRaD structure. It includes a theoretical framework of the research problem but at this point, I suggest the authors incorporate another bibliographic reference that I miss in the text:

Di Maio M, Perrone F, Conte P. Real-World Evidence in Oncology: Opportunities and Limitations. Oncologist. 2020 May;25(5):e746-e752. doi: 10.1634/theoncologist.2019-0647. Epub 2019 Dec 24. PMID: 31872939; PMCID: PMC7216461.

Focusing on the opportunity of the study, it must be said that it is useful work since the direct cost of dealing with cancer in Spain represents 4.9% of total health expenditure.

Materials and methods.

Regarding the material and methods section, the methodology is tailored to the object of study and the objectives and is explained in a transparent manner while it has been validly applied to guarantee the results. The work represents a valuable contribution to the knowledge of the cost of cancer treatment, although the cost of drugs represents approximately 62.2% and oncology drugs dispensed through pharmacies and 12.8% of the direct cost of cancer treatment. However, the cost of hospital admissions (21.7%) are missing. It would be interesting to be able to contribute these data to the present study.

Results.

The results are significant and they are presented in an adequate and understandable way not only through narration but also with self-explained tables and figures that are also well elaborated in terms of presentation. The results justify and relate to the objectives and methods and the results are of sufficient interest with the exception noted above.

Discussion.

The discussion appropriately compares the study results with other works, highlighting the main study findings. The 19.56% of the bibliography cited in the study belongs to the previous five years.

However, I would propose the inclusion of three bibliographic references in the discussion section:

Morin L, Todd A, Barclay S, Wastesson JW, Fastbom J, Johnell K. Preventive drugs in the last year of life of older adults with cancer: Is there room for deprescribing? Cancer. 2019 Jul 1;125(13):2309-2317. doi: 10.1002/cncr.32044. Epub 2019 Mar 25. PMID: 30906987.

Laura Alison Lyon, Deprescribing in Hospice: A Quality Improvement Project (QI401), Journal of Pain and Symptom Management, Volume 63, Issue 5, 2022, Pages 885-886, https://doi.org/10.1016/j.jpainsymman.2022.02.088.

Vokinger KN, Hwang TJ, Grischott T, Reichert S, Tibau A, Rosemann T, Kesselheim AS. Prices and clinical benefit of cancer drugs in the USA and Europe: a cost-benefit analysis. Lancet Oncol. 2020 May;21(5):664-670. doi: 10.1016/S1470-2045(20)30139-X. PMID: 32359489.

 

Overall, it is an interesting study and should be considered for publication in Current Oncology, once the minor revisions proposed have been resolved.

 

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

The article ” Use of Drugs in Clinical Practice and the Associated Cost of Cancer Treatment in Adult Patients with Solid Tumors: A 10- Year Real Word Evidence Ambispective Cohort Study”  describes the important part of cancer treatment and its costs. The authors used incredible data sources to provide a deep inside into drug usage in cancer treatment. The topic is very important to analyze and plan the budget for healthcare providers.

However, the manuscript must be properly developed in many areas.

Some general comments:

1.      Why do the authors use the term “Ambispective”? The data were collected retrospectively from 2010 up to 2019.  From my point of view this is a retrospective study? Obviously, if you use data on real patients from the real hospital, this is a real-world data – no needs to mention it in the title.

2.      Did the author adjusted the costs according to the years, considering the inflation, Consumer price index/else? Otherwise you cannot compare costs for 2010 with costs for 2019? I could not find those adjustments

 

The abstract:

1.      The abstract must bus structured to see the background, methods, results and conclusion.

2.      This is unclear what groups of drugs are the subject of the analyses – very difficult to follow the results.

3.      Not clear is the authors analyzed the total consumption or how it was changed during the years -  percentage of expenditure? Expenditure of the total healthcare? Very unclear.

The introduction:

1.      The introduction should be clearer and directly to the subject, will benefit to be shorter

2.      Line 67-71: provide some references

3.      I miss the motivation and the goal of the study

The methods.

1.      “Based on the mechanism of action, the following pharmacological classes were established: cytotoxic drugs, immunotherapy, targeted therapy, radiopharmaceuticals, and others” – this classification should be in the abstract

2.      The part “Information Source” was not very informative and helpful for the reader, I suggest to shorten it and move the details into appendix

3.      This is not so clear how the authors calculated “Pharmaceutical expenditure “. Was it directly from the accounting system of the hospital?  Is their some kind of “price list” for the country? How you can generalize the costs for othe hospitals/health care centers?

The results.

1.      Line 258-259: “As shown in Table 2, pharmaceutical expenditure for 258

antineoplastic drugs increased over the study period from 7.67% in relation to the total expenditure in 2010 to 12.82% in 2019.” – total expenditure for the hospital? Total expenditure of what? Healthcare? – not clear

2.      In thable 2 “Antineoplastic drugs Oncology Department” – both in-patient and outpatient?

3.      Bothe Figure 1 and Figure 2 a difficult to understand if the prices are not adjusted a particular year. And the same for all costs tables – the prices should be adjusted

The discussion

Suggest to formulate clearly the main results and if the article answered the research question.

 

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

All my comments were fully adressed