Cost Implications of the Rapid Adoption of Newer Technologies for Treating Prostate Cancer
Cost Implications of the Rapid Adoption of Newer Technologies for Treating Prostate Cancer
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DOI：
10.1200/jco.2010.31.1217
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发表时间：
2011-04-20
影响因子：
45.3
通讯作者：
Hu, Jim C.
中科院分区：
文献类型：
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作者：
Nguyen, Paul L.;Gu, Xiangmei;Hu, Jim C.
目的调强放射治疗 (IMRT) 和腹腔镜或机器人微创根治性前列腺切除术 (MIRP) 是治疗前列腺癌的三维适形放射治疗 (3D-CRT) 和开放根治性前列腺切除术的昂贵替代方案。我们评估了其利用率的时间趋势及其对国家医疗保健支出的影响。方法使用监测、流行病学和最终结果-医疗保险相关数据，我们确定了 45,636 名年龄 >= 65 岁男性的治疗模式，这些男性在 2002 年至 2005 年间诊断出局限性前列腺癌，接受了确定性手术或放射治疗。前列腺癌护理的成本是诊断后一年与诊断前一年医疗保险支付的差异。结果患者接受了手术（26%）、外部放疗（38%）或近距离放射治疗加或不加放疗（36%）。在手术患者中，MIRP 利用率大幅增加（2002 年诊断中为 1.5%，2005 年诊断中为 28.7%，P < .001）。对于 RT，IMRT 利用率大幅增加（28.7% vs 81.7%；P < .001），而对于接受近距离放射治疗的男性，补充 IMRT 显着增加（8.5% vs 31.1%；P < .001）。 IMRT 与 3D-CRT 相比的平均增量成本为 10,986 美元（按 2008 年美元计算）；近距离放射治疗加 IMRT 与近距离放射治疗加 3D-CRT 的费用为 10,789 美元； MIRP 与开放 RP 的对比为 293 美元。将这些数字外推到美国总人口中，与 2005 年诊断出的男性的成本较低的替代方案相比，调强放疗 (IMRT) 超额支出 2.82 亿美元，近距离放射治疗加调强放疗 (IMRT) 超额支出 5,900 万美元，MIRP 超额支出 400 万美元。 结论 昂贵的前列腺癌治疗方法迅速而广泛地采用，导致 2005 年诊断出的男性的国家额外支出超过 3.5 亿美元，并表明需要进行比较有效性研究来权衡其成本与收益。
PurposeIntensity-modulated radiation therapy (IMRT) and laparoscopic or robotic minimally invasive radical prostatectomy (MIRP) are costlier alternatives to three-dimensional conformal radiation therapy (3D-CRT) and open radical prostatectomy for treating prostate cancer. We assessed temporal trends in their utilization and their impact on national health care spending.MethodsUsing Surveillance, Epidemiology, and End Results-Medicare linked data, we determined treatment patterns for 45,636 men age >= 65 years who received definitive surgery or radiation for localized prostate cancer diagnosed from 2002 to 2005. Costs attributable to prostate cancer care were the difference in Medicare payments in the year after versus the year before diagnosis.ResultsPatients received surgery (26%), external RT (38%), or brachytherapy with or without RT (36%). Among surgical patients, MIRP utilization increased substantially (1.5% among 2002 diagnoses v 28.7% among 2005 diagnoses, P < .001). For RT, IMRT utilization increased substantially (28.7% v 81.7%; P < .001) and for men receiving brachytherapy, supplemental IMRT increased significantly (8.5% v 31.1%; P < .001). The mean incremental cost of IMRT versus 3D-CRT was $10,986 (in 2008 dollars); of brachytherapy plus IMRT versus brachytherapy plus 3D-CRT was $10,789; of MIRP versus open RP was $293. Extrapolating these figures to the total US population results in excess spending of $282 million for IMRT, $59 million for brachytherapy plus IMRT, and $4 million for MIRP, compared to less costly alternatives for men diagnosed in 2005.ConclusionCostlier prostate cancer therapies were rapidly and widely adopted, resulting in additional national spending of more than $350 million among men diagnosed in 2005 and suggesting the need for comparative effectiveness research to weigh their costs against their benefits.