Estimating regimen-specific costs of chemotherapy for breast cancer: Observational cohort study
Estimating regimen-specific costs of chemotherapy for breast cancer: Observational cohort study
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DOI：
10.1002/cncr.30274
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发表时间：
2016-11-15
期刊：
影响因子：
6.2
通讯作者：
Shen, Chan
中科院分区：
文献类型：
--
作者：
Giordano, Sharon H.;Niu, Jiangong;Shen, Chan
高质量患者护理的一个目标是向患者传达治疗费用，但费用信息可能难以获得。这对于乳腺癌护理尤其相关，因为存在许多与指南一致的辅助化疗方案。本研究的目的是从支付者和患者的角度在一个大的，保险的美国人口产生这种方案的成本估计。（来自MarketScan数据库），诊断后1年内无继发性恶性肿瘤，诊断后3个月内接受化疗（n= 14，643）。使用诊断后18个月内的所有索赔计算总费用和自付费用，并将其标准化为2013年美元。扩展估计方程法用于评估调整人口统计学和临床因素的治疗方案的成本。在接受和未接受曲妥珠单抗治疗的患者中，中位保险费用分别为160，590美元和82，260美元，中位自付费用分别为3381美元和2724美元。在未接受曲妥珠单抗治疗的患者中，25%的患者支付超过4712美元，10%的患者支付超过7041美元。对于接受曲妥珠单抗治疗的患者，25%的患者支付超过5604美元，10%的患者支付超过8384美元。在高免赔额健康计划覆盖的患者中，自付费用中位数为5158美元，25%至少支付8128美元，10%支付11,344美元。结论乳腺癌化疗的费用在不同方案之间差异很大，患者承担了大量的自付负担。Cancer 2016;122：3447-3455. (c)2016年美国癌症协会乳腺癌化疗的费用在不同的治疗方案中差异很大，患者承担了相当大的自付负担。这些护理成本数据可以帮助为患者和提供者之间的讨论提供信息，以确保选择经济上合适的乳腺癌治疗方法。
BACKGROUNDOne goal for high-quality patient care is communicating treatment costs to patients, yet cost information can be elusive. This is especially relevant for breast cancer care, for which numerous guideline-concordant adjuvant chemotherapy regimens exist. The objective of the current study was to generate cost estimates for such regimens from payers' and patients' perspectives in a large, insured US population.METHODSAdult women who had incident breast cancer diagnosed between 2008 and 2012 (from the MarketScan database), had no secondary malignancy within 1 year of diagnosis, and received chemotherapy within 3 months of diagnosis were included (n=14,643). Total and out-of-pocket costs were calculated using all claims within 18 months of diagnosis and were normalized to 2013 US dollars. The extended estimating equations method was used to assess cost by regimen adjusting for demographic and clinical factors.RESULTSAmong patients who did and did not receive trastuzumab, the median insurance payments were $160,590 and $82,260, respectively, and the median out-of-pocket payments were $3381 and $2724, respectively. Among patients who did not receive trastuzumab, 25% paid more than $4712, and 10% of patients paid more than $7041. For patients who did receive trastuzumab, 25% paid more than $5604, and 10% paid more than $8384. Among patients who were covered by high-deductible health plans, the median out-of-pocket cost was $5158, 25% paid at least $8128, and 10% paid$11,344.CONCLUSIONSThe costs of breast cancer chemotherapy vary widely across regimens, and patients bear a substantial out-of-pocket burden. Cancer 2016;122:3447-3455. (c) 2016 American Cancer Society The costs of breast cancer chemotherapy vary widely across regimens and patients bear a substantial out-of-pocket burden. These cost-of-care data can help inform discussions between patients and providers to ensure the selection of financially appropriate breast cancer therapies.