Continental Divide? The Attitudes of US and Canadian Oncologists on the Costs, Cost-Effectiveness, and Health Policies Associated With New Cancer Drugs
Continental Divide? The Attitudes of US and Canadian Oncologists on the Costs, Cost-Effectiveness, and Health Policies Associated With New Cancer Drugs
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DOI：
10.1200/jco.2010.29.1625
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发表时间：
2010-09-20
影响因子：
45.3
通讯作者：
Neumann, Peter J.
中科院分区：
文献类型：
--
作者：
Berry, Scott R.;Bell, Chaim M.;Neumann, Peter J.
目的 美国和加拿大的肿瘤学家在不同的医疗保健系统中工作，但两国的医生都面临着癌症药物成本上涨带来的挑战。我们比较了他们对药物费用和成本效益以及相关健康政策的态度。方法对 1,355 名美国和 238 名加拿大肿瘤内科医师（均不在魁北克省）的随机样本的调查结果进行了比较。结果 响应率为 59%。更多的美国肿瘤学家 (67% vs 52%; P < .001) 倾向于不考虑成本而获得有效的治疗，而更多的加拿大人则倾向于仅在具有成本效益的情况下才获得有效的治疗 (75% vs 58%; P < .001)。大多数（84% 美国、80% 加拿大）肿瘤学家表示，患者自付费用影响他们的治疗建议，但只有不到一半的受访者总是或经常与患者讨论治疗费用。大多数肿瘤学家赞成在承保决策中更多地使用成本效益数据（美国 80%，加拿大 69%；P = .004），但两国只有不到一半的肿瘤学家认为自己有能力使用成本效益信息。大多数肿瘤学家赞成政府控制价格（57% 美国，68% 加拿大；P = .01），但不到一半赞成由患者分摊更多费用（29% 美国，41% 加拿大；P = .004）。两国的肿瘤学家更愿意让医生和非营利机构来确定药物是否具有良好的价值。 结论 美国和加拿大的肿瘤学家尽管在不同的医疗保健系统中执业，但对于癌症药物成本、成本效益和相关政策普遍持相似的态度。研究结果支持提供教育，帮助两国的肿瘤学家使用成本效益信息并与患者讨论药物成本。
Purpose Oncologists in the United States and Canada work in different health care systems, but physicians in both countries face challenges posed by the rising costs of cancer drugs. We compared their attitudes regarding the costs and cost-effectiveness of medications and related health policy.Methods Survey responses of a random sample of 1,355 United States and 238 Canadian medical oncologists (all outside of Quebec) were compared.Results Response rate was 59%. More US oncologists (67% v 52%; P < .001) favor access to effective treatments regardless of cost, while more Canadians favor access to effective treatments only if they are cost-effective (75% v 58%; P < .001). Most (84% US, 80% Canadian) oncologists state that patient out-of-pocket costs influence their treatment recommendations, but less than half the respondents always or frequently discuss the costs of treatments with their patients. The majority of oncologists favor more use of cost-effectiveness data in coverage decisions (80% US, 69% Canadian; P = .004), but fewer than half the oncologists in both countries feel well equipped to use cost-effectiveness information. Majorities of oncologists favor government price controls (57% US, 68% Canadian; P = .01), but less than half favor more cost-sharing by patients (29% US, 41% Canadian; P = .004). Oncologists in both countries prefer to have physicians and nonprofit agencies determine whether drugs provide good value.Conclusion Oncologists in the United States and Canada generally have similar attitudes regarding cancer drug costs, cost-effectiveness, and associated policies, despite practicing in different health care systems. The results support providing education to help oncologists in both countries use cost-effectiveness information and discuss drug costs with their patients.