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

癌症的总医疗费用估计约占全国医疗支出的5%， 占医疗保险支出的10%。在评估癌症时，准确地衡量医疗费用是很重要的 干预措施、癌症临床试验、与癌症患者有关的社会实验以及方案和政策 与癌症预防、筛查和治疗有关。这项研究将利用卫生组织的优势 研究网络(HMORN)的独特资源，以解决与以下方式相关的关键问题 常规护理药物和基于药房的新型癌症疗法会影响与癌症相关的医疗成本。 具体来说，我们提出了以下目标： 目标1-我们将对临床药学和治疗(P&T)委员会的领导人进行调查 15 HMORN的肿瘤学药剂师和首席肿瘤学家计划更好地了解政策和 与使用新的癌症疗法有关的指南，与决策过程有关的因素为什么 以及何时采用和/或控制治疗(例如，成本、法律索赔、科学证据、可见性、 社区标准，患者要求)，因费用而拒绝癌症治疗的患者比例， 以及与注射/输注癌症疗法的自动化数据相关的问题。 目标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)与总保健费用的差异 癌症总体和护理的每个特定组成部分，特别强调 所有癌症患者和下列特定癌症部位：乳腺癌、前列腺癌、肺癌/支气管炎和结肠癌/直肠癌 癌症。将对所有治疗阶段(诊断/治疗、监测和生命终结)进行估计 对65岁及以上的人有独特估计的所有人)。 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)、化学预防的扩散速度 过去十年在医疗保险中开发的药物、新的化疗药物和新的治疗方法 HMO和FFS的参与者。我们将描述这些疗法对患者的相对成本、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提供的扩大药物覆盖范围的影响和 2003年《现代化法案》(D部分)--关于与癌症有关的药物服务的估计和总体 按癌症部位、治疗阶段和人口阶层(年龄/种族/性别)分列的医疗保健使用和费用 联邦医疗保险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.