Year: 2000
Type: article
Abstract: Patient Costs on Clinical TrialsTwo recent publications (1-3) provide important information regarding a major disincentive to clinical trial participation-cost of care.Mayo Clinic data.Wagner et al. (1,2) identified a minimally increased cost of care for patients enrolled in cancer clinical trials among residents of Olmsted County, MN.A source of possible bias is increased intensity of care unrelated to the clinical trial as patients near the end of life, and the authors have made a creditable attempt to begin to study this variable in Table 5 of their article (1) and their erratum (2).Wagner et al. concluded that increased cost of care at the end of life was more common in cancer patients enrolled in clinical trials than in the control group.This bias is likely because, in my experience, patients consenting to clinical trials seek the best possible outcomes and any hope possible.Such patients often seek all possible supportive measures and intensive treatment near the end of life, in contrast to nonparticipants in clinical trials who are often more accepting of hospice-type symptom care only.To adjust for this possible bias, I recalculated the 1-year cost of care for clinical trial patients and control patients.I subtracted the care costs during the last 6 months of life for those patients who died during the first year of follow-up (Table 1).When the final 6 months of care are excluded, there is an increased mean cost of care in control patients compared with clinical trial patients (a net saving on clinical trials of 4.7%).It would be instructive for the authors to validate this conclusion using source data. Kaiser Permanente data.Fireman et al. (3) analyzed patients treated in clinical trials at Kaiser Permanente Hospitals compared with patients treated off clinical trials (3).However, because the authors at Kaiser Permanente compared a number of totally different types of therapy, it seemed instructive to contrast the costs of treatment on clinical trials
Institution: Kaiser Permanente
Language: English
Topic: Ethics in Clinical Research
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2108562713