Healthcare costs associated with skeletal-related events in breast cancer patients with bone metastases.
Healthcare costs associated with skeletal-related events in breast cancer patients with bone metastases.
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DOI：
10.3111/13696998.2014.890937
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发表时间：
2014-03-01
影响因子：
2.4
通讯作者：
Chung, Karen
中科院分区：
文献类型：
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作者：
Hagiwara, May;Delea, Thomas E;Chung, Karen
背景：继发于乳腺癌的骨转移患者易发生骨骼相关事件（SREs），包括脊髓压迫（SCC）、病理性骨折（PF）、骨手术（SB）和骨放疗（RT）。目的：记录目前乳腺癌和骨转移患者的医疗保健利用模式和SREs的成本。方法：这是一项回顾性观察性研究，使用2002年9月至2011年6月Thomson MedStat MarketScan商业索赔和遭遇数据库。研究对象包括所有声称患有乳腺癌和骨转移的患者，以及≥1例SRE的患者。根据无SRE索赔至少90天的间隔来确定独特的SRE发作，并根据治疗环境（住院或门诊）和SRE类型（SCC、PF、SB或RT）进行分类。结果：在17266例乳腺癌合并骨转移患者中，9142例（53%）有一次或多次SRE发作。在5809例符合所有其他标准的患者中，在17.2（15.2）个月的平均（SD）随访期间，有7617例SRE发作。需要住院治疗的发作百分比从11% （RT）到76% （SB）不等。平均而言，住院SCC发作（n=83次）是最昂贵的；而门诊PF发作（n=552次）成本最低。在SRE总成本（平均[SE] $21,072[$36,462]/次）中，36%归因于门诊RT （n=5265次），31%归因于住院PF （n=838次）。局限性：本研究中使用的行政索赔数据可能缺乏识别临床事件的敏感性和特异性，并且可能无法推广到其他人群。此外，对于某些SRE事件类别，事件数量较少，成本估计可能缺乏准确性。结论：在乳腺癌和骨转移患者中，SREs与高费用和住院有关。
BACKGROUND: Patients with bone metastases secondary to breast cancer are pre-disposed to skeletal-related events (SREs), including spinal cord compression (SCC), pathologic fracture (PF), surgery to bone (SB), and radiotherapy to bone (RT).OBJECTIVE: To document current patterns of healthcare utilization and costs of SREs in patients with breast cancer and bone metastases.METHODS: This was a retrospective, observational study using the Thomson MedStat MarketScan Commercial Claims and Encounters database from 9/2002 to 6/2011. Study subjects included all persons with claims for breast cancer and for bone metastases, and ≥1 claims for an SRE. Unique SRE episodes were identified based on a gap of at least 90 days without an SRE claim, and classified by treatment setting (inpatient or outpatient) and SRE type (SCC, PF, SB, or RT).RESULTS: Of 17,266 patients with breast cancer and bone metastases, 9142 (53%) had one or more SRE episodes. Among 5809 patients who met all other criteria, there were 7617 SRE episodes over mean (SD) follow-up of 17.2 (15.2) months. The percentage of episodes that required inpatient treatment ranged from 11% (RT) to 76% (SB). On average, inpatient SCC episodes (n=83 episodes) were most costly; while outpatient PF episodes (n=552 episodes) were least costly. Of the total SRE costs (mean [SE] $21,072 [$36,462]/episode), 36% were attributable to outpatient RT (n=5265 episodes) and 31% to inpatient PF (n=838 episodes).LIMITATIONS: The administrative claims data used in this study may lack sensitivity and specificity for identification of clinical events and may not be generalizable to other populations. Also, for some SRE episode categories, the number of events was small and cost estimates may lack precision.CONCLUSION: In patients with breast cancer and bone metastases, SREs are associated with high costs and hospitalizations.