Clinical model of lifetime cost of treating bladder cancer and associated complications
Clinical model of lifetime cost of treating bladder cancer and associated complications
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DOI：
10.1016/j.urology.2006.03.062
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发表时间：
2006-09-01
期刊：
影响因子：
2.1
通讯作者：
Elting, Linda S.
中科院分区：
文献类型：
--
作者：
Avritscher, Elenir B. C.;Cooksley, Catherine D.;Elting, Linda S.
目标。估算膀胱癌患者的生命周期成本及并发症在总成本中的贡献。我们回顾了从1991年到1999年在我们综合癌症中心登记的208名膀胱癌患者的回顾性队列的医疗记录。我们将膀胱癌治疗过程中使用的资源数量乘以他们的单位费用。我们使用联邦医疗保险的费用与费用比率将费用转换为成本，并将其膨胀为2005美元。我们通过创建两个极端的假设情景来估计未来的成本。在最好的情况下，我们假设浅表性疾病的患者以队列的平均复发率发展，肌肉侵袭性疾病的患者在确定的治疗后是无病的。在这两种情况下，存活率都是基于美国人的预期寿命。在最坏的情况下，我们假设患有浅表性疾病的患者发展为肌肉侵袭性疾病，所有患者随后都死于膀胱癌。在队列患者中，膀胱癌的平均成本为65,158美元。其中60%(39,393美元)用于监测和治疗复发，30%(19,811美元)用于并发症。膀胱癌的终生成本在最坏的情况下(99,270美元)低于最好的情况下(120,684美元)。然而，更大比例的费用归因于并发症，最坏的情况(43%，42,290美元)与最好的情况(28%，34,169美元)相比。膀胱癌及其相关并发症的治疗带来了重大的经济负担。预防并发症的更具成本效益的监测战略和方法对于最大限度地减少疾病的临床和经济后果至关重要。(C)2006年爱思唯尔公司。
Objectives. To estimate the lifetime cost of bladder cancer and the contribution of complications to the total costs.Methods. We reviewed the medical records of a retrospective cohort of 208 patients with bladder cancer who registered at our comprehensive cancer center from 1991 to 1999. We multiplied the number of resources used during management of bladder cancer by their unit charges. We converted charges into costs using the Medicare cost-to-charge ratio and inflated these to 2005 U.S. dollars. We estimated future costs by creating two extreme hypothetical scenarios. In the best-case scenario, we assumed patients with superficial disease developed recurrences at the cohort's mean rate and that patients with muscle-invasive disease were disease free after definitive therapy. Survival was based on the U.S. life expectancy in both cases. In the worst-case scenario, we assumed patients with superficial disease developed muscle-invasive disease and that all patients subsequently died of bladder cancer.Results. The average cost of bladder cancer was $65,158 among the cohort patients. Sixty percent of this cost ($39,393) was associated with surveillance and treatment of recurrences, and 30% ($19,81 1) was attributable to complications. The lifetime cost of bladder cancer was lower for the worst-case scenario ($99,270) than for the best-case scenario ($120,684). However, a greater proportion of the costs were attributable to complications with the worst-case scenario (43%, $42,290) compared with the best (28%, $34,169).Conclusions. The management of bladder cancer and its associated complications results in a major economic burden. More cost-effective surveillance strategies and approaches for preventing complications are crucial to minimizing the disease's clinical and economic consequences. (c) 2006 Elsevier Inc.