Elting Linda S, Shih Ya-Chen Tina
Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
Support Care Cancer. 2004 Apr;12(4):219-26. doi: 10.1007/s00520-003-0513-1. Epub 2004 Feb 7.
Economic and regulatory healthcare policy is limited by the lack of population-based information on the cost of supportive care of cancer patients. The goal of this study was to estimate these costs and to explore the impact of these costs on policy decisions.
We identified estimates of the cost of outpatient and inpatient supportive care from published reports in the literature. The range of these costs (from lowest to highest) is described for each supportive care condition. These estimates were supplemented by computing the cost of all hospitalizations for these conditions in Texas between June 2000 and December 2001. Medicare payments were used to estimate average reimbursement. Costs (not charges) were standardized to 2002 US dollars using the consumer price index for medical care and Medicare's cost-to-charge ratio for Texas.
Inpatient care for most conditions exceeded 7,000 US dollars per episode. Our population-based estimates of the cost of care were similar to literature-based estimates, except in the case where conditions could be managed in the outpatient setting. Average Medicare payments were often far lower than the estimated cost of care. For example, the estimated cost of hospitalization for management of diarrhea was 6,616 US dollars while the average Medicare payment was only 2,809 US dollars.
Many supportive care interventions are quite expensive. In an environment focused on cost containment, a risk-based approach to expensive supportive care treatments is essential. Further study of the cost effectiveness of supportive care management strategies is indicated.
由于缺乏基于人群的癌症患者支持性护理成本信息，医疗保健的经济和监管政策受到限制。本研究的目的是估算这些成本，并探讨这些成本对政策决策的影响。
我们从文献中已发表的报告中确定了门诊和住院支持性护理成本的估算值。针对每种支持性护理情况描述了这些成本的范围（从最低到最高）。通过计算2000年6月至2001年12月期间德克萨斯州这些情况的所有住院费用对这些估算值进行了补充。使用医疗保险支付来估算平均报销额。使用医疗保健消费者价格指数和德克萨斯州医疗保险的成本收费比，将成本（而非收费）标准化为2002年美元。
大多数情况下，每次住院护理费用超过7000美元。我们基于人群的护理成本估算值与基于文献的估算值相似，但在可以在门诊环境中管理的情况下除外。医疗保险的平均支付额往往远低于估计的护理成本。例如，腹泻管理的住院估计成本为6616美元，而医疗保险的平均支付额仅为2809美元。
许多支持性护理干预措施相当昂贵。在注重成本控制的环境中，对昂贵的支持性护理治疗采取基于风险的方法至关重要。表明需要进一步研究支持性护理管理策略的成本效益。
