PROJECT 2 - ECONOMIC BURDEN OF CANCER: IMPACT OF AGE, STAGE, COMORBIDITIES AND

据估计，癌症的医疗保健总费用约占国家医疗保健支出的5%， 医疗费用的10%。在评估癌症时，医疗费用的准确测量非常重要 干预措施、癌症临床试验、与癌症患者相关的社会实验以及计划和政策 与癌症预防、筛查和治疗有关。这项研究将利用HMO 研究网络（HMORN）的独特资源，以解决有关的方式， 常规护理药物和基于药物的新型癌症疗法影响癌症相关的医疗保健成本。 具体而言，我们提出以下目标： 目的1 -我们将对药学和治疗学（P&T）委员会的领导人，临床 肿瘤药剂师和首席肿瘤学家在15 HMORN计划更好地了解如何政策和 与使用新的癌症疗法相关的指南，与决策过程相关的因素， 以及当采用和/或控制治疗时（例如，成本、法律的索赔、科学证据、知名度， 社区标准，患者需求），由于费用而拒绝癌症治疗的患者比例， 以及与注射/输注癌症治疗的自动化数据相关的问题。 目的2 -使用2000-2007年HMORN内四个计划的数据，我们将估计 福利覆盖范围和费用分摊（患者自付费用）对总医疗保健费用的变化， 癌症的整体和每一个具体的组成部分的护理，特别强调药物成本， 所有癌症患者和以下特定癌症部位：乳腺、前列腺、肺/支气管和结肠/直肠 癌的将对所有治疗阶段（诊断/治疗、监测和生命结束）进行估计 对所有人的估计数为65岁和65岁以上者。 目标3 -使用2000-2007年的HMORN数据和2006-2007年的Medicare Part D索赔数据，我们将估计 靶向化疗药物、集落刺激因子（CSF）、化学预防性化疗药物的扩散速率 药物，新的化疗药物和新的治疗方法在过去十年中开发的医疗保险 HMO和FFS注册者。我们将描述这些疗法对患者、健康计划和 医疗保险 AIM 4 -使用2000-2007年的HMORN数据和2006-2007年的SEER-Medicare数据，我们将对 医疗保险处方药改进计划提供的药品覆盖范围扩大的影响，以及 2003年《现代化法》（D部分），关于癌症相关药物服务和总体估计 按癌症部位、治疗阶段和人口统计学分层（年龄/种族/性别）列出的医疗保健使用和费用， Medicare FFS和HMO受益人。

Total medical care costs of cancers are estimated to be about 5% of national health care expenditures and 10% of Medicare outlays. Accurate measures of medical care costs are important when evaluating cancer interventions, cancer clinical trials, social experiments related to cancer patients, and programs and policies related to cancer prevention, screening, and treatment. This research will take advantage of the HMO Research Network's (HMORN) unique resources to address vital questions related to the manner in which usual care drugs and novel pharmacy-based cancer therapies impact cancer-related health care costs. Specifically we propose the following aims: AIM 1 - We will conduct a survey of leaders of Pharmacy and Therapeutics (P&T) committees, clinical oncology pharmacists, and chief oncologists at the 15 HMORN plans to better understand how policies and guidelines related to the use of new cancer therapies, factors related to the decision-making process for why and when therapies were adopted and/or controlled (e.g., costs, legal claims, scientific evidence, visibility, community standards, patient demands), proportion of patients who refuse cancer therapies due to costs, and issues related to automated data on injection/infused cancer therapies. AIM 2 - Using data from four plans within the HMORN for 2000-2007, we will estimate the effects of variations in benefit coverage and cost sharing (patient out-of-pocket costs) on the total health care costs of cancer overall and for each specific component of care, with a specific emphasis on pharmaceutical costs for all cancer patients and the following specific cancer sites: breast, prostate, lung/bronchus, and colon/rectum cancers. Estimates will be made for all treatment phases (diagnosis/treatment, monitoring, and end-of-life care) for all persons with unique estimates for persons aged 65 and older. Aim 3 - Using HMORN data for 2000-2007 and Medicare Part D claims data for 2006-2007, we will estimate the rates of diffusion of targeted chemotherapy agents, colony-stimulating factors (CSFs), chemopreventive agents, new chemotherapy agents, and novel therapies developed during the past decade among Medicare HMO and FFS enrollees. We will describe the relative costs of these therapies to patients, health plans, and Medicare. AIM 4 - Using HMORN data for 2000-2007, and SEER-Medicare data for 2006-2007, we will model the effects of the increased drug coverage provided by the Medicare Prescription Drug Improvement and Modernization Act of 2003 (Part D) on estimates of cancer-related pharmaceutical services and overall medical care use and costs by cancer site, phase of treatment, and demographic strata (age/race/gender) for Medicare FFS and HMO beneficiaries.