Presentation (CTI)

OBJECTIVES: Older adults with cancer are at high risk of treatment-related adverse events (AEs) and unplanned hospitalization, which increase healthcare resource utilization. Although geriatric assessment and management (GAM) before cancer treatment has been shown to reduce AEs, its potential economic impact in Japan has not been evaluated. This study estimated the potential cost savings of GAM for older adults with cancer in Japan.
METHODS: We performed a scenario-based cost-saving analysis using Japanese public data sources, including the National Cancer Registry, NDB Open Data, and the Survey Report on Medical Care Benefit Expenditures. We estimated the number of patients aged ≥70 years receiving systemic cancer therapy and the incidence of Grade ≥3 AEs. Febrile neutropenia (FN) was selected as a representative hospitalization-requiring AE for cost estimation. Based on clinical guidelines, GAM was assumed to be four 1-hour outpatient, physician-led sessions: one prior to treatment and three follow-up sessions over the subsequent 6 months.
RESULTS: An estimated 156,088 patients aged ≥70 years received inpatient systemic cancer therapy. The GAM cost was estimated at JPY 23,388 per patient, totaling JPY 3.65 billion. The incidence of Grade ≥3 AEs was 52%. For Grade ≥3 FN, the incidence was 15%, with a hospitalization cost of JPY 271,610 per episode. Modeling the GAM effect as a 21% relative reduction in Grade ≥3 AEs (based on Akseer et al), the estimated savings from reduced FN hospitalizations were JPY 1.34 billion. Although GAM implementation costs exceeded FN-related savings by JPY 2.32 billion, GAM would become cost saving if other AEs generated additional savings of at least JPY 190,893 per affected patient.
CONCLUSIONS: Pretreatment GAM demonstrates potential cost-saving viability for older adults with cancer in Japan. Further studies should evaluate cost reductions from other AEs and conduct a comprehensive cost-effectiveness analysis incorporating QALYs.