title: Clinicians' adherence versus non adherence to practice guidelines in the management of patients with sarcoma: a cost-effectiveness assessment in two European regions.
abstract: BACKGROUND
  Although the management of sarcoma is improving, non adherence to clinical practice guidelines (CPGs) remains high, mainly because of the low incidence of the disease and the variety of histological subtypes. Since little is known about the health economics of sarcoma, we undertook a cost-effectiveness analysis (within the CONnective TIssue CAncer NETwork, CONTICANET) comparing costs and outcomes when clinicians adhered to CPGs and when they did not.
  
  
  METHODS
  Patients studied had a histological diagnosis of sarcoma, were older than 15 years, and had been treated in the Rhône-Alpes region of France (in 2005/2006) or in the Veneto region of Italy (in 2007). Data collected retrospectively for the three years after diagnosis were used to determine relapse free survival and health costs (adopting the hospital's perspective and a microcosting approach). All costs were expressed in euros (€) at their 2009 value. A 4% annual discount rate was applied to both costs and effects. The incremental cost-effectiveness ratio (ICER) was expressed as cost per relapse-free year gained when management was compliant with CPGs compared with when it was not. To capture uncertainty surrounding ICER, a probabilistic sensitivity analysis was performed based on a non-parametric bootstrap method.
  
  
  RESULTS
  A total of 219 patients were included in the study. Compliance with CPGs was observed for 118 patients (54%). Average total costs reached 23,571 euros when treatment was in accordance with CPGs and 27,313 euros when it was not. In relation to relapse-free survival, compliance with CPGs strictly dominates non compliance, i.e. it is both less costly and more effective. Taking uncertainty into account, the probability that compliance with CPGs still strictly dominates was 75%.
  
  
  CONCLUSIONS
  Our findings should encourage physicians to increase their compliance with CPGs and healthcare administrators to invest in the implementation of CPGs in the management of sarcoma.
authors.affiliation: University of Lyon, F-69007 Lyon, France. lionel.perrier@lyon.unicancer.fr
authors.forename: Lionel
authors.initials: L
authors.lastname: Perrier
authors.forename: Alessandra
authors.initials: A
authors.lastname: Buja
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mastrangelo
authors.forename: Antonella
authors.initials: A
authors.lastname: Vecchiato
authors.forename: Paolo
authors.initials: P
authors.lastname: Sandonà
authors.forename: Françoise
authors.initials: F
authors.lastname: Ducimetière
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Blay
authors.forename: François Noël
authors.initials: FN
authors.lastname: Gilly
authors.forename: Carole
authors.initials: C
authors.lastname: Siani
authors.forename: Pierre
authors.initials: P
authors.lastname: Biron
authors.forename: Dominique
authors.initials: D
authors.lastname: Ranchère-Vince
authors.forename: Anne-Valérie
authors.initials: AV
authors.lastname: Decouvelaere
authors.forename: Philippe
authors.initials: P
authors.lastname: Thiesse
authors.forename: Christophe
authors.initials: C
authors.lastname: Bergeron
authors.forename: Angelo Paolo
authors.initials: AP
authors.lastname: Dei Tos
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Coindre
authors.forename: Carlo Riccardo
authors.initials: CR
authors.lastname: Rossi
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ray-Coquard
mesh_terms: D000368:Aged; D002391:Catchment Area, Health; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care / Q000191:economics* / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000191:economics / Q000473:pathology / Q000628:therapy; D047368:Tumor Burden