Longitudinal Trends in Costs of Palliative Radiation for Metastatic Prostate Cancer
Longitudinal Trends in Costs of Palliative Radiation for Metastatic Prostate Cancer
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DOI：
10.1089/jpm.2015.0171
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发表时间：
2015-11-01
影响因子：
2.8
通讯作者：
Reed, Shelby D.
中科院分区：
文献类型：
--
作者：
Robinson, Timothy J.;Dinan, Michaela A.;Reed, Shelby D.
背景：近年来，前列腺癌转移的姑息治疗的特点是使用更复杂的放射治疗，尽管缺乏证据证明这些技术在姑息治疗中的临床益处。一般患者群体对采用这些技术对转移性前列腺癌患者姑息放射治疗成本的影响仍知之甚少。方法：该研究对 2000 年至 2007 年间死于转移性前列腺癌并在生命最后一年接受骨转移放射治疗的 66 岁及以上男性的监测、流行病学和最终结果 (SEER) 医疗保险数据进行了回顾性分析。直接费用来自 Medicare 承运人和门诊设施支付的所有放射治疗索赔，并调整为 2008 年美元。结果：共有 1705 名男性符合研究纳入标准。生命最后一年骨转移放射治疗的医疗保险支付总额增加了 44.4%，从 2000 年的平均 2,763 美元增加到 2007 年的 3,989 美元，医院机构内累积的所有支付比例从 48% 增加到 57%。同期放射治疗技术的复杂性的特点是使用不太简单（30.1％至23.3％）和更复杂（59.9％对66.7％）的放射治疗。从2000-2003年到2004-2007年，较短疗程（5个分次）的使用从22%减少到14%，单次疗程的使用减少了一半（6.3%到2.9%；P.001）。结论：2000年至2007年间，前列腺癌骨转移姑息性放射治疗的特点是采用更先进的治疗技术和延长放射治疗疗程。有必要进一步研究调查具有成本效益的姑息治疗的障碍。
Background: In recent years, palliative treatment of prostate cancer metastases has been characterized by the use of more complex radiation treatment, despite a lack of evidence demonstrating a clinical benefit of these technologies in the palliative setting. The impact of adoption of these technologies on the costs of palliative radiation treatment in patients with metastatic prostate cancer remains poorly understood in the general patient population. Methods: The study was a retrospective analysis of Surveillance, Epidemiology and End Results (SEER) Medicare data of men aged 66 and older who died from metastatic prostate cancer between 2000 and 2007 and received radiation therapy for bony metastases in the last year of life. Direct costs were obtained from Medicare carrier and outpatient facility payments for all radiation treatment claims and adjusted to 2008 dollars. Results: A total of 1705 men met study inclusion criteria. Total Medicare payments for radiation therapy for bony metastases in the last year of life increased by 44.4% from an average of $2,763 in 2000 to $3,989 in 2007, with the proportion of all payments accrued within hospital-based settings increasing from 48% to 57%. Complexity of radiation therapy techniques over the same period was characterized by use of less simple (30.1% to 23.3%) and more complex (59.9% versus 66.7%) radiation therapy. From 2000-2003 to 2004-2007, the use of shorter treatment courses (5 fractions) decreased from 22% to 14%, and the use of single fraction treatment courses decreased by half (6.3% to 2.9%; P.001). Conclusions: Between 2000 and 2007, palliative radiation therapy for bony prostate cancer metastases was characterized by the use of more advanced treatment technologies and prolonged radiation treatment courses. Further research investigating barriers to cost-effective palliation is warranted.