Health Care Resource Utilization for Esophageal Cancer Using Proton versus Photon Radiation Therapy.
Health Care Resource Utilization for Esophageal Cancer Using Proton versus Photon Radiation Therapy.
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DOI：
10.14338/ijpt-22-00001.1
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发表时间：
2022
影响因子：
1.7
通讯作者：
Smith, Grace L.
中科院分区：
文献类型：
--
作者：
Lin, Steven H.;Liao, Kaiping;Lei, Xiudong;Verma, Vivek;Shaaban, Sherif;Lee, Percy;Chen, Aileen B.;Koong, Albert C.;Hoftstetter, Wayne L.;Frank, Steven J.;Liao, Zhongxing;Shih, Ya-Chen Tina;Giordano, Sharon H.;Smith, Grace L.
关键词：
在接受食管癌（EC）放化疗的患者中，随机试验数据表明，与调强放射治疗（IMRT）相比，质子束治疗（PBT）可减少毒性和术后并发症（POC）。然而，放射治疗方式是否会影响术后医疗资源的利用仍不清楚。我们检查了287例接受放化疗的EC患者（处方剂量50.4戈伊/GyE），随后进行食管切除术，包括2007年至2013年接受PBT（n = 81）与IMRT（n = 156）治疗的237例连续患者的真实世界观察性队列;以及一项独立的当代比较队列，其中50例患者来自2012年至2019年接受PBT（n = 21）与IMRT（n = 29）治疗的随机试验。从病历中提取术后并发症。卫生保健费用来自机构索赔，并根据通货膨胀（2021年美元）进行了调整。使用伽马分布的校正广义线性模型，按治疗比较电荷差异（Δ = $PBT-$IMRT）。基线PBT与IMRT特征无显著差异。在观察队列中，在新辅助放化疗阶段，PBT的医疗费用高于IMRT（Δ = +$71，959; 95%置信区间[CI]，$62，274-$82，138; P < .001）。手术费用没有差异（Δ =-2234美元; 95% CI，-6003至1695美元; P = 0.26）。然而，在食管切除术后住院期间，PBT的医疗费用低于IMRT（Δ = − 25，115美元; 95% CI，− 37，625至− 9776美元; P = .003）。在对照组中，结果相似：在放化疗期间，PBT的费用高于IMRT（Δ = +$61，818; 95%CI，$49，435-$75，069; P < .001），手术无差异（Δ = − 4784美元; 95% CI，− 6439美元至3487美元; P = 0.25），术后PBT较低（Δ = − 27,048美元; 95% CI，− 41,974美元至− 5300美元; P = 0.02）。在当代比较中，PBT的术后费用较低尤其见于任何POC患者（Δ = − 176，448美元; 95% CI，− 209，782至− 78，813美元; P = 0.02）。术后EC患者PBT的前期放化疗资源利用率较高，部分被POC风险降低所抵消。结果扩展了PBT毒性降低的现有临床证据。
In patients treated with chemoradiation for esophageal cancer (EC), randomized trial data demonstrate that proton beam therapy (PBT) reduces toxicities and postoperative complications (POCs) compared with intensity-modulated radiation therapy (IMRT). However, whether radiation therapy modality affects postoperative health care resource utilization remains unknown. We examined 287 patients with EC who received chemoradiation (prescribed 50.4 Gy/GyE) followed by esophagectomy, including a real-world observational cohort of 237 consecutive patients treated from 2007 to 2013 with PBT (n = 81) versus IMRT (n = 156); and an independent, contemporary comparison cohort of 50 patients from a randomized trial treated from 2012 to 2019 with PBT (n = 21) versus IMRT (n = 29). Postoperative complications were abstracted from medical records. Health care charges were obtained from institutional claims and adjusted for inflation (2021 dollars). Charge differences (Δ = $PBT − $IMRT) were compared by treatment using adjusted generalized linear models with the gamma distribution. Baseline PBT versus IMRT characteristics were not significantly different. In the observational cohort, during the neoadjuvant chemoradiation phase, health care charges were higher for PBT versus IMRT (Δ = +$71,959; 95% confidence interval [CI], $62,274–$82,138; P < .001). There was no difference in surgical charges (Δ = −$2234; 95% CI, −$6003 to $1695; P = .26). However, during postoperative hospitalization following esophagectomy, health care charges were lower for PBT versus IMRT (Δ = −$25,115; 95% CI, −$37,625 to −$9776; P = .003). In the comparison cohort, findings were analogous: Charges were higher for PBT versus IMRT during chemoradiation (Δ = +$61,818; 95% CI, $49,435–$75,069; P < .001), not different for surgery (Δ = −$4784; 95% CI, −$6439 to $3487; P = .25), and lower for PBT postoperatively (Δ = −$27,048; 95% CI, −$41,974 to −$5300; P = .02). Lower postoperative charges for PBT were especially seen among patients with any POCs in the contemporary comparison (Δ = −$176,448; 95% CI, −$209,782 to −$78,813; P = .02). Higher up-front chemoradiation resource utilization for PBT in patients with EC was partially offset postoperatively, moderated by reduction in POC risks. Results extend existing clinical evidence of toxicity reduction with PBT.