Uptake and costs of hypofractionated vs conventional whole breast irradiation after breast conserving surgery in the United States, 2008-2013.
Uptake and costs of hypofractionated vs conventional whole breast irradiation after breast conserving surgery in the United States, 2008-2013.
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DOI：
10.1001/jama.2014.16616
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发表时间：
2014-12-17
影响因子：
120.7
通讯作者：
Emanuel, Ezekiel J.
中科院分区：
文献类型：
--
作者：
Bekelman, Justin E.;Sylwestrzak, Gosia;Barron, John;Liu, Jinan;Epstein, Andrew J.;Freedman, Gary;Malin, Jennifer;Emanuel, Ezekiel J.
基于随机证据，2011年的专家指南批准了对选定的早期乳腺癌患者进行较短的低分割全乳房放射治疗(WBI)，并允许其他患者进行低分割全乳房放射治疗。研究美国商业保险患者接受低分割的WBI的情况和成本。回顾、观察性队列研究，使用14个商业医疗保健计划的行政索赔数据，覆盖7.4%的美国成年女性，我们将2008年和2013年接受肿块切除和全身照射治疗的早期乳腺癌患者分为两组：(1)低分割认可的队列(n=8924)包括50岁或以上的患者，既往没有化疗或腋窝淋巴结受累；(2)允许低分割的队列(n=6719)包括50岁以下的患者或既往有化疗或腋窝淋巴结受累的患者。低分割WBI(治疗3-5周)与常规WBI(治疗5-7周)。使用低分割和常规的WBI、总的和与放射治疗相关的医疗费用以及患者自付费用。患者和临床特征包括治疗年份、年龄、合并疾病、既往化疗、腋窝淋巴结受累、调强放射治疗、实践环境和其他背景变量。在低分馏认可的队列中，低分馏WBI从2008年的10.6%(95%CI，8.8%-12.5%)增加到2013年的34.5%(95%CI，32.2%-36.8%)，在允许低分馏的队列中，从2008年的8.1%(95%CI，6.0%-10.2%)上升到2013年的21.2%(95%CI，18.9%-23.6%)。诊断后1年的调整后平均总医疗费用在低分馏认可的队列中为28747美元，而在低分馏认可的队列中为31641美元(差异，2894美元；95%CI，1,610-4234美元；P<；.001)；在允许低分馏的队列中，为273美元，传统的WBI为72860美元(差异，8587美元；95%CI，5316-12017美元；P<；.001)。在两个队列中，调整后的平均1年患者自付总费用在低分化组和常规WBI组之间没有显著差异。在2008年至2013年的14个美国商业医疗保健计划中，早期乳腺癌患者中保乳手术后的低分割WBI增加了。然而，2013年，只有34.5%的低分割认可的早期乳腺癌患者和21.2%的低分割允许的早期乳腺癌患者接受了低分割的WBI。
Based on randomized evidence, expert guidelines in 2011 endorsed shorter, hypofractionated whole breast irradiation (WBI) for selected patients with early-stage breast cancer and permitted hypofractionated WBI for other patients. To examine the uptake and costs of hypofractionated WBI among commercially insured patients in the United States. Retrospective, observational cohort study, using administrative claims data from 14 commercial health care plans covering 7.4%of US adult women in 2013, we classified patients with incident early-stage breast cancer treated with lumpectomy and WBI from 2008 and 2013 into 2 cohorts: (1) the hypofractionation-endorsed cohort (n = 8924) included patients aged 50 years or older without prior chemotherapy or axillary lymph node involvement and (2) the hypofractionation-permitted cohort (n = 6719) included patients younger than 50 years or those with prior chemotherapy or axillary lymph node involvement. Hypofractionated WBI (3–5 weeks of treatment) vs conventional WBI (5–7 weeks of treatment). Use of hypofractionated and conventional WBI, total and radiotherapy-related health care expenditures, and patient out-of-pocket expenses. Patient and clinical characteristics included year of treatment, age, comorbid disease, prior chemotherapy, axillary lymph node involvement, intensity-modulated radiotherapy, practice setting, and other contextual variables. Hypofractionated WBI increased from 10.6%(95%CI, 8.8%–12.5%) in 2008 to 34.5%(95%CI, 32.2%–36.8%) in 2013 in the hypofractionation-endorsed cohort and from 8.1% (95%CI, 6.0%–10.2%) in 2008 to 21.2%(95%CI, 18.9%–23.6%) in 2013 in the hypofractionation-permitted cohort. Adjusted mean total health care expenditures in the 1 year after diagnosis were $28 747 for hypofractionated and $31 641 for conventional WBI in the hypofractionation-endorsed cohort (difference, $2894; 95%CI, $1610–$4234; P < .001) and $64 273 for hypofractionated and $72 860 for conventional WBI in the hypofractionation-permitted cohort (difference, $8587; 95%CI, $5316–$12 017; P < .001). Adjusted mean total 1-year patient out-of-pocket expenses were not significantly different between hypofractionated vs conventional WBI in either cohort. Hypofractionated WBI after breast conserving surgery increased among women with early-stage breast cancer in 14 US commercial health care plans between 2008 and 2013. However, only 34.5%of patients with hypofractionation-endorsed and 21.2%with hypofractionation-permitted early-stage breast cancer received hypofractionated WBI in 2013.
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影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
3.4
作者：
Gold, Heather T.;Do, Huong T.
通讯作者：
Do, Huong T.
DOI：
10.1016/j.ijrobp.2011.05.074
发表时间：
2012-05-01
影响因子：
7
作者：
Dorn, Paige L.;Corbin, Kimberly S.;Chmura, Steven J.
通讯作者：
Chmura, Steven J.
影响因子：
2.5
作者：
Clark, Jeanne M.;Chang, Hsien-Yen;Weiner, Jonathan P.
通讯作者：
Weiner, Jonathan P.
影响因子：
3.9
作者：
Harnett, Adrian
通讯作者：
Harnett, Adrian