Comparison of Approaches for Estimating Prevalence Costs of Care for Cancer Patients What Is the Impact of Data Source?
Comparison of Approaches for Estimating Prevalence Costs of Care for Cancer Patients What Is the Impact of Data Source?
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DOI：
10.1097/mlr.0b013e3181a23e25
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发表时间：
2009-07-01
期刊：
影响因子：
3
通讯作者：
Brown, Martin L.
中科院分区：
文献类型：
--
作者：
Yabroff, K. Robin;Warren, Joan L.;Brown, Martin L.
背景：国家普遍的医疗保健成本可以是卫生政策决策的关键投入。成本估计因数据来源、患者人群和方法而异，然而，本研究的目的是比较3种方法，使用不同的数据来源，但相似的患者人群和方法来估计结直肠癌（CRC）护理的患病率成本。（1）关联的监测流行病学和最终结果（SEER）登记-医疗保险数据，（2）仅医疗保险索赔，以及（3）医疗支出小组调查（MEPS）。对照组按性别、年龄组和地理位置进行匹配。在类似的观察期内，比较了每种方法的平均每人总成本和净成本，作为患者和对照组之间的差异。我们参考了SEER-医疗保险方法，并通过敏感性分析评估了患者选择标准的影响。总患病率估计也compared.Results：我们发现相当大的差异在不同的方法来估计CRC的患病率成本。SEER-Medicare参考中的人均年净估计值为5341美元（95%CI：5243美元，5439美元），而仅Medicare索赔为8736美元（95%CI：8203美元，9269美元），MEPS为11，614美元（95%CI：7566美元，15，663美元）。2004年CRC净流行成本的国家总估计数从45.24亿美元（使用SEER-医疗保险方法）到96.29亿美元（使用MEPS方法）不等。估计不同的数据来源的基础上的支付者包括和确定流行的CRC patients.Conclusions：CRC患病率的成本估计有很大的不同，这取决于数据来源。我们的研究结果对估计其他癌症和其他疾病的流行成本具有影响，而这些疾病没有可用于识别新诊断个体以及最近诊断的个体的登记系统。
Background: National prevalence costs of medical care can be key inputs in health policy decisions. Cost estimates vary across data sources, patient populations, and methods, however, the objective of this study was to compare 3 approaches for estimating the prevalence costs of colorectal cancer (CRC) care using different data sources, but similar patient populations and methods.Methods: We identified prevalent CRC patients aged 65 and older from: (1) linked Surveillance Epidemiology and End Results (SEER) registry-Medicare data, (2) Medicare claims only, and (3) the Medical Expenditure Panel Survey (MEPS). Controls were matched by sex, age-group, and geographic location. Mean per person total and net costs, measured as the difference between patients and controls, were compared for each approach during a similar observation period. The SEER-Medicare approach was our reference, and we evaluated the impact of patient selection criteria with sensitivity analyses. Aggregate prevalence estimates were also compared.Results: We found considerable variability across the different approaches to estimating prevalence costs of CRC. Mean net annual per person estimates in the SEER-Medicare reference were $5341 (95% CI: $5243, $5439), compared with $8736 (95% CI: $8203, $9269) for the Medicare claims only and $11,614 (95% CI: $7566, $15,663) for the MEPS. Aggregate national estimates of net prevalence costs of CRC in 2004 ranged from $4524 million, using the SEER-Medicare approach, to $9629 million, using the MEPS approach. Estimates varied by data source based on the payors included and identification of prevalent CRC patients.Conclusions: CRC prevalence cost estimates vary substantially depending on the data sources. Our findings have implications for estimating prevalence costs for other cancers and other diseases without registry systems that can be used to identify newly diagnosed individuals as well as those diagnosed less recently.