Cost Implications and Complications of Overtreatment of Low-Risk Prostate Cancer in the United States
Cost Implications and Complications of Overtreatment of Low-Risk Prostate Cancer in the United States
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DOI：
10.6004/jnccn.2015.0009
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发表时间：
2015-01-01
影响因子：
13.4
通讯作者：
Nguyen, Paul L.
中科院分区：
文献类型：
--
作者：
Aizer, Ayal A.;Gu, Xiangmei;Nguyen, Paul L.
背景资料：循证共识指南建议仅对低风险前列腺癌和预期寿命不到10年的男性进行观察。本报告描述了美国低风险前列腺癌过度治疗的发生率、驱动因素、成本和发病率。研究方法：SEER-医疗保险计划用于确定2004年至2007年诊断为低风险前列腺癌的11，744名66岁或以上男性。前列腺癌的过度治疗被定义为对预期寿命不到10年的患者进行确定性治疗。使用NCCN方法估计预期生存期。费用是医疗保险在诊断前减去一年后支付的金额。毒性是相关的医疗保险诊断/干预。P值为双侧。结果：在3001名低风险前列腺癌患者中，预期寿命不到10年，2011名男性（67%）过度治疗。多变量logistic回归分析显示，过度治疗的男性更可能已婚（比值比[OR]，1.29; 95%CI，1.05-1.59; P=.02），居住在富裕地区（P
Background: Evidence-based consensus guidelines recommend only observation for men with low-risk prostate cancer and life expectancy less than 10 years. This report describes the incidence, drivers, cost, and morbidity of overtreatment of low-risk prostate cancer within the United States. Methods: The SEER-Medicare Program was used to identify 11,744 men aged 66 years or older diagnosed with low-risk prostate cancer in 2004 through 2007. Overtreatment of prostate cancer was defined as definitive treatment of a patient with a life expectancy of less than 10 years. Expected survival was estimated using NCCN methodology. Costs were the amount paid by Medicare in years after minus year before diagnosis. Toxicities were relevant Medicare diagnoses/interventions. P values are 2-sided. Results: Of 3001 men with low-risk prostate cancer and a life expectancy of less than 10 years, 2011 men (67%) were overtreated. On multivariable logistic regression, overtreated men were more likely to be married (odds ratio [OR], 1.29; 95% CI, 1.05-1.59; P=.02), reside in affluent regions (P