Jayadevappa Ravishankar, Bloom Bernard S, Chhatre Sumedha, Fomberstein Kenneth M, Wein Alan J, Malkowicz S Bruce
Department of Medicine, Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA.
J Urol. 2005 Sep;174(3):1059-64; discussion 1064. doi: 10.1097/01.ju.0000169526.75984.89.
We evaluated health related quality of life (HRQOL) and the direct medical care cost (DMC) in young men receiving radical prostatectomy.
In this prospective cohort study, 40 newly diagnosed patients with prostate cancer (PCa) who were younger than 65 years were matched with 40 cancer-free men. Participants completed the Medical Outcome Study Short Form and UCLA-PCa Index surveys prior to treatment, and at 3, 6, 12 and 24-month followup. Cost data were obtained from a hospital based administrative database and clinical data were obtained via structured medical chart review. Demographics and HRQOL were compared using the t, Fisher exact and chi-square tests. The Wilcoxon and log-T tests were used to compare DMC. Multivariate regression models were used to assess the incremental cost of PCa and predictors of 24-month prostate specific HRQOL.
Patients with PCa had a mean annual DMC of 4,160 dollars for the treatment year with a mean length of stay of 3.5 days. They had 3-fold higher DMC than controls. At 12 months, generic HRQOL values were similar to baseline values. Sexual function showed trends toward improvement 6 months after surgery. Urinary function improved significantly by 6 months, although it decreased thereafter. Bowel function and bother returned to baseline values by 3 months. On multivariate regression marital status was a significant predictor of 5 domains of prostate specific HRQOL at 24 months.
Patients with PCa reported weaker sexual function, urinary function and sexual bother at 2 years after treatment compared with their baseline values. There exists an opportunity for improving prostate specific HRQOL in men with early stage PCa.
我们评估了接受根治性前列腺切除术的年轻男性的健康相关生活质量（HRQOL）和直接医疗费用（DMC）。
在这项前瞻性队列研究中，将40名新诊断的年龄小于65岁的前列腺癌（PCa）患者与40名无癌男性进行匹配。参与者在治疗前以及3、6、12和24个月随访时完成了医学结局研究简表和加州大学洛杉矶分校前列腺癌指数调查。费用数据从基于医院的行政数据库中获取，临床数据通过结构化病历审查获得。使用t检验、Fisher精确检验和卡方检验比较人口统计学和HRQOL。使用Wilcoxon检验和对数T检验比较DMC。多变量回归模型用于评估PCa的增量成本和24个月前列腺特异性HRQOL的预测因素。
PCa患者治疗年度的平均年度DMC为4160美元，平均住院时间为3.5天。他们的DMC比对照组高3倍。在12个月时，一般HRQOL值与基线值相似。性功能在术后6个月有改善趋势。排尿功能在6个月时显著改善，尽管此后有所下降。肠道功能和困扰在3个月时恢复到基线值。在多变量回归中，婚姻状况是24个月时前列腺特异性HRQOL 5个领域的显著预测因素。
与基线值相比，PCa患者在治疗后2年报告性功能、排尿功能和性困扰较弱。早期PCa男性存在改善前列腺特异性HRQOL的机会。
