Comparative effectiveness, cost, and utilization of radical prostatectomy among young men within managed care insurance plans.
Comparative effectiveness, cost, and utilization of radical prostatectomy among young men within managed care insurance plans.
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管理式医疗保险计划中年轻男性根治性前列腺切除术的有效性、成本和利用率的比较。
DOI：
10.1016/j.jval.2011.10.008
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Elting,LindaS
中科院分区：
文献类型：
--
作者：
Shih,Ya-ChenTina;Ward,JohnF;Pettaway,CurtisA;Xu,Ying;Matin,SurenaF;Davis,JohnW;Thompson,BenjaminP;Elting,LindaS
背景美国年轻男性(65岁)前列腺癌新疗法的成本和收益还不是很清楚。我们在年轻患者中比较了两种根治性前列腺切除术(RP)--微创前列腺切除术(MIRP)和耻骨后前列腺切除术(RRP)--的利用率、临床结果和费用。方法我们从商业索赔数据库LifeLink Health Plan Claims数据库中提取2003年至2007年期间接受MIRP或RRP治疗的10,669名患者的信息。在未调整的分析中，我们使用卡方检验来比较临床结果，使用非参数自举方法来比较MIRP组和RRP组之间的成本。我们应用Logistic、Cox比例风险和扩展估计方程方法，在控制年龄、合并症和健康计划特征的情况下，检查手术方式与围手术期并发症、吻合口狭窄和费用之间的关系。结果MIRP下前列腺切除术的比例从2003年的5.7%上升到2007年的50.3%。共病越多的患者比MIRP更有可能接受RRP。与RRP组相比，MIRP组的围手术期并发症发生率(23.0%vs.30.4%；P<；0.001)和吻合口狭窄倾向(风险比0.42；95%CI 0.35~0.50)显著低于RRP组，但尽管住院时间较短(1.7d vs.3.1d；P<；0.001)，但住院费用较高(19998美元vs.18,424美元；P<；0.001)。在对共病评分为0的患者进行的亚组分析中也报告了类似的发现。结论：随着时间的推移，非老年患者的MIRP显著增加。MIRP的并发症较少。较低的并发症费用似乎抵消了MIRP较高的住院费用。
Background Costs and benefits of emerging prostate cancer treatments for young men (age< 65 years) in the United States are not well understood. We compared utilization, clinical outcomes, and costs between two types of radical prostatectomy (RP)—minimally invasive prostatectomy (MIRP) and retropubic prostatectomy (RRP)—among young patients. Methods We extracted from LifeLink Health Plan Claims Database, a commercial claims database, information on 10,669 patients receiving either MIRP or RRP between 2003 and 2007. In unadjusted analyses, we used chi-square tests to compare clinical outcomes and nonparametric bootstrapping method to compare costs between the MIRP and RRP groups. We applied logistic, Cox proportional hazard, and extended estimation equation methods to examine the association between surgical modality and perioperative complications, anastomotic stricture, and costs while controlling for age, comorbidity, and health plan characteristics. Results The percentage of prostatectomies performed as MIRP increased from 5.7% in 2003 to 50.3% in 2007. Patients with more comorbidity were more likely to undergo RRP than MIRP. Compared with the RRP group, the MIRP group had a significantly lower rate of perioperative complications (23.0% vs. 30.4%; P< 0.001) and a lesser tendency for anastomotic strictures (hazard ratio 0.42; 95% CI 0.35–0.50) within the first postoperative year but had higher hospitalization costs ($19,998 vs. $18,424; P< 0.001) despite shorter hospitalizations (1.7 days vs. 3.1 days; P< 0.001). Similar findings were reported in the subgroup analysis of patients with comorbidity score 0. Conclusion MIRP among nonelderly patients increased substantially over time. MIRP was found to have fewer complications. Lower costs of complications appeared to have offset higher hospitalization costs of MIRP.