Ira Leeds

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Regionalization of rectal cancer surgery has well-recognized associated advantages. It increases lymph node yield, it increases the use of neoadjuvant therapy, it decreases 30 and 90-day mortality, and then presumably through these benefits, it is also associated with a 34% decrease in 5-year mortality.
quote · Rectal Cancer
In some healthcare systems, a community oncologist presents every single one of their rectal cancer cases to an entire board across the entire system.
clinical · Rectal Cancer

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Ira's statements about Rectal Cancer 20 statements

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Best of the Best Gen Surg - How Far is Too Far Cost-effectiveness Analysis of Regionalized Rectal Cancer Surgery - Dr. Leeds

Statement Regionalization of rectal cancer surgery is associated with a 34% decrease in 5-year mortality. Open
Statement Regionalization of rectal cancer surgery increases lymph node yield. Open
Quotation Regionalization of rectal cancer surgery has well-recognized associated advantages. It increases lymph node yield, it increases the use of neoadjuvant therapy, it decreases 30 and 90-day mortality, and then presumably through these benefits, it is also associated with a 34% decrease in 5-year mortality. Open
Statement Regionalization of rectal cancer surgery increases the use of neoadjuvant therapy. Open
Statement Regionalization of rectal cancer surgery decreases 30 and 90-day mortality. Open
Statement More than 3 times the number of patients would have to travel more than 50 miles to achieve regionalized care compared to local care. Open
Statement Patients who travel for regionalized rectal cancer surgery tend to be more white and more privately insured, raising issues of healthcare equity. Open
Statement The marginal cost per patient in the decision tree model was cheaper with regionalized care compared to local care. Open
Statement The decision tree model showed a mortality benefit in the regionalized arm versus the local arm. Open
Quotation This is a cost effectiveness condition called economic dominance, or where the costs of care are cheaper in the same arm that also has better clinical benefit. Open
Statement Regionalized rectal cancer surgery demonstrates economic dominance, with both lower costs and better clinical benefit than local care. Open
Quotation In conclusion, regionalized rectal cancer surgery is the dominant cost-effective strategy compared to local rectal cancer surgery. Local rectal cancer surgery is rarely cost-effective in this model under even the most extreme sensitivity scenarios. Open
Statement In sensitivity analysis of over 10,000 scenarios, nearly all scenarios showed regionalization as the dominant strategy with lower costs and better effectiveness than local care. Open
Statement Cost-effectiveness methodologies are particularly helpful for population level decision making but less helpful for individual patient selection. Open
Statement Local rectal cancer surgery is rarely cost-effective in this model under even the most extreme sensitivity scenarios. Open
Statement The model ran through 10,000 iterations with very wide confidence bars around each estimate to test robustness. Open
Statement Regionalized care per case is more expensive than local care when looking only at case costs. Open
Statement In 97.8% of the model scenarios, regionalized care won out over local care when including downstream costs of cancer recurrence and early death. Open
Statement In some healthcare systems, a community oncologist presents every single one of their rectal cancer cases to an entire board across the entire system. Open
Statement The data is not yet good enough to support a regionalized decentralized model for rectal cancer care. Open