Costs Associated With Imaging Surveillance After Treatment for Head and Neck Cancer
Costs Associated With Imaging Surveillance After Treatment for Head and Neck Cancer
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DOI：
10.1001/jamaoto.2021.0835
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发表时间：
2021-05-13
影响因子：
7.8
通讯作者：
Bhayani, Mihir K.
中科院分区：
文献类型：
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作者：
Nocon, Cheryl C.;Kennedy, Aimee;Bhayani, Mihir K.
重要性 国家综合癌症网络建议在头颈癌 (HNC) 治疗后 6 个月内进行影像学检查。仅当患者出现症状或体检发现异常时，才建议进一步进行影像学检查。然而，在许多情况下，无症状患者继续进行影像学评估。 目的 评估 HNC 患者监测影像学的实践模式，并评估与这些影像学实践相关的成本。 设计、设置和参与者 这项单机构回顾性经济评估研究筛选了 435 名患者，以确定 2010 年 1 月 1 日至 12 月 31 日期间新诊断为头颈部粘膜和唾液腺恶性肿瘤的患者。 2016 年。数据分析于 2018 年 10 月 25 日至 2020 年 11 月 24 日进行。暴露影像学实践模式。主要结果和措施监测期间所有患者、无病患者和复发患者的影像学研究数量和费用。结果 共有 136 名患者（诊断时平均 [SD] 年龄，62 [14] 岁；84 [61.8%]该研究纳入了 106 名（77.9%）白人）患有 HNC 的男性。口咽是最常见的亚部位 (64 [47.1%])，大多数 HNC 为 IVA 期 (62 [45.6%])，大多数患者接受了明确的放射治疗 (71 [52.2%])。在 3.2 年（范围为 0.3-6.8 年）的中位监测期间，对所有患者进行了 14 (10) 次影像学研究的平均 (SD)，平均 (SD) 总费用为 36 800 美元 (24 500 美元)。对于保持无病状态的患者，在监测期间进行了 13 (10) 次影像学研究的平均 (SD)，平均 (SD) 总费用为 35 000 美元（21 700 美元）。无症状的患者每年平均 (SD) 进行 4 (3) 项研究，导致每年平均费用为 9600 美元 (5900 美元)。与保持无疾病的患者相比，发生复发的患者每年进行更多的研究（平均差，5.0；95% CI，3.4-6.6），相关平均费用更高（平均差，10 600 美元；95% CI，$6100-15 000）。 结论和相关性 在这项经济评估研究中，许多接受 HNC 治疗的患者接受了超出国家综合癌症网络推荐的影像学检查指导方针。这些发现表明，需要根据当前医疗保健环境中常规成像所获得的价值来考虑无症状患者的成像成本负担。
IMPORTANCE The National Comprehensive Cancer Network recommends imaging within 6 months after treatment for head and neck cancer (HNC). Further imaging is recommended only if the patient has symptoms or abnormal findings on physical examination. However, in many instances, asymptomatic patients continue to have imaging evaluations.OBJECTIVES To assess practice patterns in surveillance imaging in patients with HNC and evaluate the costs associated with these imaging practices.DESIGN, SETTING, AND PARTICIPANTS This single-institution retrospective economic evaluation study screened 435 patients to identify patients newly diagnosed with head and neck mucosal and salivary gland malignant tumors between January 1, 2010, and December 31, 2016. Data analyses were performed from October 25, 2018, to November 24, 2020.EXPOSURE Imaging practice patterns.MAIN OUTCOMES AND MEASURES Number and costs of imaging studies during the surveillance period for all patients, patients who remained disease free, and patients who developed recurrence.RESULTS A total of 136 patients (mean [SD] age at diagnosis, 62 [14] years; 84 [61.8%] male; 106 [77.9%] White) with HNC were included in the study. The oropharynx was the most common subsite (64 [47.1%]), most HNCs were stage IVA (62 [45.6%]), and most patients received definitive radiation-based treatment (71 [52.2%]). During the median surveillance period of 3.2 years (range, 0.3-6.8 years), a mean (SD) of 14 (10) imaging studies were performed for all patients, with a mean (SD) total cost of $36 800 ($24 500). In patients who remained disease free, a mean (SD) of 13 (10) imaging studies were performed during the surveillance period, with a mean (SD) total cost of $35 000 ($21 700). Patients who lacked symptoms had a mean (SD) of 4 (3) studies performed per year, resulting in a mean cost of $9600 ($5900) per year. Patients who developed recurrence had more studies per year of follow-up (mean difference, 5.0; 95% CI, 3.4-6.6) and higher associated mean costs (mean difference, $10 600; 95% CI, $6100-$15 000) than patients who remained disease free.CONCLUSIONS AND RELEVANCE In this economic evaluation study, many patients treated for HNCs received imaging studies beyond what is recommended by National Comprehensive Cancer Network guidelines. These findings suggest that the cost burden of imaging in the asymptomatic patient needs to be considered against the value obtained from routine imaging in this current health care environment.