Lang Kathleen, Menzin Joseph, Earle Craig C, Jacobson Jerilynn, Hsu Ming-Ann
Boston Health Economics Inc, Waltham, Mass, USA.
Arch Otolaryngol Head Neck Surg. 2004 Nov;130(11):1269-75. doi: 10.1001/archotol.130.11.1269.
To evaluate the excess mortality, resource use, and costs associated with squamous cell carcinoma of the head and neck (SCCHN) among elderly Medicare beneficiaries.
Retrospective cohort analysis using data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute and Medicare claims.
Study cohorts included patients aged 65 years and older who were newly diagnosed as having SCCHN in a SEER registry between 1991 and 1993 (N = 4536) and controls matched 1:1 by age and sex. Patients were followed up for 5 years or until death, whichever occurred first.
Initial treatment was primarily surgery and/or radiation among patients with early-stage SCCHN, with only modest use of chemotherapy. Patients with SCCHN had significantly (P<.001) higher 5-year mortality (64% vs 25%) and health care costs than controls. Average Medicare payments (1998 US dollars) among patients with SCCHN were $25 542 higher than those of matched comparison patients (P<.001), with monthly payments 3 times as high ($1428 vs $446). Patients diagnosed as having advanced SCCHN had shorter survival times (5-year mortality, 85%, 75%, 47%, and 35% among patients diagnosed as having distant, regional, local, and in situ cancer, respectively) and higher costs (average total Medicare payments, $53 741, $58 387, $42 698, and $37 434, respectively).
These results suggest that the health economic burden of SCCHN is substantial, with costs that are comparable with or higher than those of other solid tumors.
评估老年医疗保险受益人头颈部鳞状细胞癌（SCCHN）的超额死亡率、资源利用情况及相关费用。
利用美国国立癌症研究所监测、流行病学和最终结果（SEER）计划的数据及医疗保险理赔数据进行回顾性队列分析。
研究队列包括1991年至1993年间在SEER登记处新诊断为SCCHN的65岁及以上患者（N = 4536），以及按年龄和性别1:1匹配的对照组。对患者进行5年随访或直至死亡，以先发生者为准。
早期SCCHN患者的初始治疗主要为手术和/或放疗，化疗使用较少。SCCHN患者的5年死亡率（64%对25%）和医疗费用显著高于对照组（P <.001）。SCCHN患者的平均医疗保险支付（1998年美元）比匹配的对照患者高25542美元（P <.001），每月支付高出3倍（1428美元对446美元）。诊断为晚期SCCHN的患者生存时间较短（分别诊断为远处、区域、局部和原位癌的患者5年死亡率分别为85%、75%、47%和35%）且费用较高（平均医疗保险总支付分别为53741美元、58387美元、42698美元和37434美元）。
这些结果表明，SCCHN的健康经济负担巨大，其费用与其他实体瘤相当或更高。
