Assessing surveillance utilization and value in commercially insured patients with colorectal cancer.
Assessing surveillance utilization and value in commercially insured patients with colorectal cancer.
复制标题
DOI：
10.37765/ajmc.2022.89147
复制
发表时间：
2022-05-01
影响因子：
3.2
通讯作者：
Bansal, Aasthaa
中科院分区：
文献类型：
--
作者：
Suh, Kangho;Shankaran, Veena;Bansal, Aasthaa
结直肠癌（CRC）监测检测的现实模式及其对健康和成本结果的影响在很大程度上是未知的。我们的目的是：1)评估癌胚抗原（CEA）检测、计算机断层扫描（CT）扫描和结肠镜检查应用的趋势；2)通过表征复发治疗的接受情况和测量直接医疗费用来检验CEA检测强度的价值。前瞻性队列我们使用IBM®MarketScan®数据库来识别2008年至2015年间诊断和治疗的结直肠癌患者。我们使用负二项模型来评估CEA检测的使用率，使用logistic模型来评估CT扫描和结肠镜检查的使用率。我们使用Cox比例风险模型来评估监测强度和治愈治疗时间。我们使用Kaplan-Meier样本平均估计值来估计直接医疗费用，以解释审查费用。我们确定了3197名符合条件的患者。在研究期间，CEA检查、CT扫描和结肠镜检查的平均次数保持相对稳定，但对指南的依从性因监测而异。当根据CEA使用对指南的依从性（完全利用者和过度利用者）对个体进行分类时，相对于完全利用者，过度利用者的治愈性治疗风险比为2.11 （95% CI:(1.46, 3.05)）。虽然与完全服用者相比，过度服用者接受复发治疗的可能性更高，但该组的直接医疗费用要高得多。超过指南建议的监测强度可能导致更早发现复发并进行后续治疗，但这与直接医疗费用的显著增加有关。监测检测趋势最近保持相对稳定，过度使用监测措施的患者复发检测更快，但成本更高。
Real-world patterns of surveillance testing in colorectal cancer (CRC) and the effects on health and cost outcomes are largely unknown. Our objectives were to: 1) assess trends in carcinoembryonic antigen (CEA) testing, computerized tomography (CT) scans, and colonoscopy utilization; and 2) examine the value of CEA testing intensity by characterizing receipt of curative treatment for recurrence and measuring direct medical costs. Prospective cohort We used IBM® MarketScan® databases to identify patients diagnosed and treated for CRC between 2008 and 2015. We used a negative binomial model to assess utilization of CEA testing and logistic models to assess utilization of CT scans and colonoscopies. We used a Cox proportional hazards model to assess surveillance intensity and time to curative treatment. We estimated direct medical costs using the Kaplan-Meier sample average estimator to account for censored costs. We identified 3,197 eligible patients. The average number of CEA tests, CT scans, and colonoscopies remained relatively constant in the study period, but adherence to guidelines varied by surveillance. When categorizing individuals by their CEA utilization adherence to guidelines (perfect-utilizers and over-utilizers), over-utilizers had a hazard ratio for curative treatment of 2.11 (95% CI: (1.46, 3.05)) relative to perfect-utilizers. Although over-utilizers underwent potentially curative procedures for recurrence at higher rates compared to perfect-utilizers, direct medical costs were much higher in this group. Higher intensity of surveillance beyond what is recommended by guidelines may lead to earlier recurrence detection and subsequent treatment, but this is associated with significantly higher direct medical costs. Surveillance test trends remained relatively stable recently, and patients who over-utilized surveillance measures had quicker recurrence detection but at higher costs.
登录
查看更多内容
影响因子：
9.8
作者：
Murphy, Caitlin C.;Lewis, Carmen L.;Golin, Carol E.;Sandler, Robert S.
通讯作者：
Sandler, Robert S.
DOI：
10.1001/jama.2018.5816
发表时间：
2018-05-22
期刊：
JAMA
影响因子：
--
作者：
Snyder RA;Hu CY;Cuddy A;Francescatti AB;Schumacher JR;Van Loon K;You YN;Kozower BD;Greenberg CC;Schrag D;Venook A;McKellar D;Winchester DP;Chang GJ;Alliance for Clinical Trials in Oncology Network Cancer Surveillance Optimization Working Group
通讯作者：
Alliance for Clinical Trials in Oncology Network Cancer Surveillance Optimization Working Group
影响因子：
254.7
作者：
Siegel, Rebecca;Ma, Jiemin;Jemal, Ahmedin
通讯作者：
Jemal, Ahmedin
影响因子：
4.4
作者：
Lejeune, Catherine;Binquet, Christine;Bonithon-Kopp, Claire
通讯作者：
Bonithon-Kopp, Claire
影响因子：
3.2
作者：
Körner, H;Söreide, K;Söreide, JA
通讯作者：
Söreide, JA