Growth Of High-Cost Intensity-Modulated Radiotherapy For Prostate Cancer Raises Concerns About Overuse
Growth Of High-Cost Intensity-Modulated Radiotherapy For Prostate Cancer Raises Concerns About Overuse
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DOI：
10.1377/hlthaff.2011.1062
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发表时间：
2012-04-01
期刊：
影响因子：
9.7
通讯作者：
Hollenbeck, Brent K.
中科院分区：
文献类型：
--
作者：
Jacobs, Bruce L.;Zhang, Yun;Hollenbeck, Brent K.
为了研究新的、昂贵的、未经证实的治疗前列腺癌的方法的影响，我们调查了调强放疗（IMRT）的传播。调强放射治疗是前列腺癌的一种创新治疗方法，与其他放射疗法相比，它可以提供更高剂量的辐射，并提高精度。从2001年到2007年，我们观察到这种新的治疗方法在诊断为前列腺癌的男性中迅速采用，尽管其相对有效性尚不确定。我们比较了接受调强放射治疗和以前的放射标准治疗（三维适形治疗）的患者和疾病特征;评估了中期结局;并检查了与调强放射治疗使用增加相关的潜在因素。我们发现，在IMRT采用的早期（2001-03年），男性高危患者更有可能接受IMRT，而在IMRT的初始传播（2004-07年）后，男性低风险患者接受IMRT的可能性与男性高危患者相当。这引起了人们对过度治疗的担忧，以及相当大的医疗保健费用，因为IMRT治疗的费用比其他标准疗法高出15，000 - 20，000美元。随着医疗服务改革的推进，政策制定者必须在推广新的、未经证实的技术与过度使用的风险之间取得平衡。
To study the impact of new, expensive, and unproven therapies to treat prostate cancer, we investigated the dissemination of intensity-modulated radiotherapy (IMRT). IMRT is an innovative treatment for prostate cancer that delivers higher doses of radiation with improved precision compared to alternative radiotherapies. We observed rapid adoption of this new treatment among men diagnosed with prostate cancer from 2001 through 2007, despite uncertainty about its relative effectiveness. We compared patient and disease characteristics of those receiving IMRT and the previous radiation standard of care, three-dimensional conformal therapy; assessed intermediate-term outcomes; and examined potential factors associated with the increased use of IMRT. We found that in the early period of IMRT adoption (2001-03) men with high-risk disease were more likely to receive IMRT, whereas after IMRT's initial dissemination (2004-07) men with low-risk disease had fairly similar likelihoods of receiving IMRT as men with high-risk disease. This raises concerns about overtreatment, as well as considerable health care costs, because treatment with IMRT costs $15,000-$20,000 more than other standard therapies. As health care delivery reforms gain traction, policy makers must balance the promotion of new, yet unproven, technology with the risk of overuse.