Kutikova Lucie, Bowman Lee, Chang Stella, Long Stacey R, Obasaju Coleman, Crown William H
Eli Lilly and Company, Lilly Corporate Center, DC 1833, Indianapolis, IN 46285, USA.
Lung Cancer. 2005 Nov;50(2):143-54. doi: 10.1016/j.lungcan.2005.06.005. Epub 2005 Aug 19.
The economic burden of lung cancer was examined with a retrospective case-control cohort study on a database containing inpatient, outpatient and drug claims for employees, dependents and retirees of multiple large US employers with wide geographic distribution. Patients were followed for maximum of 2 years from first cancer diagnosis until death, health benefits dis-enrollment or study end (31 December 2000). Compared with controls (subjects without any cancer), patients with lung cancer (n = 2040) had greater health care service utilization and costs for hospitalization, emergency room visits, outpatient office visits, radiology procedures, laboratory procedures and pharmacy-dispensed drugs (all P < 0.05). Regression-adjusted mean monthly total costs were US dollar 6520 for patients versus US dollar 339 for controls (P < 0.0001), and overall costs across the study period (from diagnosis to death or maximum of 2 years) were US dollar 45,897 for patients and US dollar 2907 for controls (P < 0.0001). The main cost drivers were hospitalization (49.0% of costs) and outpatient office visits (35.2% of costs). Monthly initial treatment phase costs (US dollar 11,496 per patient) were higher than costs during the secondary treatment phase (US dollar 3733) or terminal care phase (US dollar 9399). Failure of initial treatment was associated with markedly increased costs. Compared with patients requiring only initial treatment, patients experiencing treatment failure accrued an additional US dollar 10,370 per month in initial treatment phase costs and US dollar 8779 more per month after starting the secondary and/or terminal care phase. Over the course of the study period, these patients had total costs of US dollar 120,650, compared with US dollar 45,953 for those receiving initial treatment only. Thus, the incremental costs associated with treatment failure were US dollar 19,149 per month and US dollar 74,697 across the study period. Other types of clinical and epidemiological analysis are needed to identify risks for treatment failure. The economic burden of lung cancer on the US health care system is significant and increased prevention, new therapies or adjuvant chemotherapy may reduce both resource use and healthcare costs. New strategies for lung cancer that reduce hospitalizations and/or prevent or delay treatment failure could offset some of the economic burden associated with the disease.
通过一项回顾性病例对照队列研究，利用一个包含美国多个大型雇主的员工、家属和退休人员的住院、门诊及药品报销信息的数据库，对肺癌的经济负担进行了研究。这些雇主分布广泛。从首次癌症诊断开始，对患者进行最长2年的随访，直至死亡、医保退保或研究结束（2000年12月31日）。与对照组（无任何癌症的受试者）相比，肺癌患者（n = 2040）在住院、急诊就诊、门诊就诊、放射检查、实验室检查及药房配药方面的医疗服务利用率和费用更高（所有P < 0.05）。经回归调整后，患者的月均总成本为6520美元，而对照组为339美元（P < 0.0001）；整个研究期间（从诊断到死亡或最长2年），患者的总成本为45,897美元，对照组为2907美元（P < 0.0001）。主要成本驱动因素是住院（占成本的49.0%）和门诊就诊（占成本的35.2%）。每月的初始治疗阶段成本（每位患者11,496美元）高于二线治疗阶段（3733美元）或终末期护理阶段（9399美元）的成本。初始治疗失败与成本显著增加相关。与仅需初始治疗的患者相比，经历治疗失败的患者在初始治疗阶段每月的成本额外增加10,370美元，在开始二线和/或终末期护理阶段后每月额外增加8779美元。在整个研究期间，这些患者的总成本为120,650美元，而仅接受初始治疗的患者为45,953美元。因此，与治疗失败相关的增量成本为每月19,149美元，整个研究期间为74,697美元。需要进行其他类型的临床和流行病学分析来确定治疗失败的风险。肺癌给美国医疗保健系统带来的经济负担巨大，加强预防、采用新疗法或辅助化疗可能会减少资源使用和医疗成本。降低住院率和/或预防或延迟治疗失败的肺癌新策略可能会抵消与该疾病相关的部分经济负担。
