Warren Joan L, Yabroff K Robin, Meekins Angela, Topor Marie, Lamont Elizabeth B, Brown Martin L
Health Services and Economics Branch/Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Executive Plaza North, Rm 4005, 6130 Executive Blvd, MSC 7344, Bethesda, MD 20892-7344, USA.
J Natl Cancer Inst. 2008 Jun 18;100(12):888-97. doi: 10.1093/jnci/djn175. Epub 2008 Jun 10.
Despite reports of increases in the cost of cancer treatment, little is known about how costs of cancer treatment have changed over time and what services have contributed to the increases.
We used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database for 306,709 persons aged 65 and older and diagnosed with breast, lung, colorectal, or prostate cancer between 1991 and 2002 to assess the number of patients assigned to initial cancer care, from 2 months before diagnosis to 12 months after diagnosis, and mean annual Medicare payments for this care according to cancer type and type of treatment. Mutually exclusive treatment categories were cancer-related surgery, chemotherapy, radiation therapy, and other hospitalizations during the period of initial cancer care. Linear regression models were used to assess temporal trends in the percentage of patients receiving treatment and costs for those treated. We extrapolated our results based on the SEER data to the US Medicare population to estimate national Medicare payments by cancer site and treatment category. All statistical tests were two-sided.
For patients diagnosed in 2002, Medicare paid an average of $39,891 for initial care for each lung cancer patient, $41 134 for each colorectal cancer patient, and $20,964 for each breast cancer patient, corresponding to inflation-adjusted increases from 1991 of $7139, $5345, and $4189, respectively. During the same interval, the mean Medicare payment for initial care for prostate cancer declined by $196 to $18261 in 2002. Costs for any hospitalization accounted for the largest portion of payments for all cancers. Chemotherapy use increased markedly for all cancers between 1991 and 2002, as did radiation therapy use (except for colorectal cancers). Total 2002 Medicare payments for initial care for these four cancers exceeded $6.7 billion, with colorectal and lung cancers being the most costly overall.
The statistically significant increase in costs of initial cancer treatment reflects more patients receiving surgery and adjuvant therapy and rising prices for these treatments. These trends are likely to continue in the near future, although more efficient targeting of costly therapies could mitigate the overall economic impact of this trend.
尽管有报道称癌症治疗成本有所增加，但对于癌症治疗成本随时间如何变化以及哪些服务导致了成本增加，人们了解甚少。
我们使用了监测、流行病学和最终结果（SEER）-医疗保险关联数据库中的数据，该数据库涵盖了1991年至2002年间年龄在65岁及以上、被诊断患有乳腺癌、肺癌、结直肠癌或前列腺癌的306,709人，以评估从诊断前2个月到诊断后12个月接受初始癌症治疗的患者数量，以及根据癌症类型和治疗类型计算的该治疗的平均年度医疗保险支付费用。在初始癌症治疗期间，相互排斥的治疗类别包括与癌症相关的手术、化疗、放疗以及其他住院治疗。使用线性回归模型来评估接受治疗的患者百分比和治疗费用的时间趋势。我们根据SEER数据将结果外推至美国医疗保险人群，以估计按癌症部位和治疗类别划分的全国医疗保险支付费用。所有统计检验均为双侧检验。
对于2002年诊断出的患者，医疗保险为每位肺癌患者的初始治疗平均支付39,891美元，为每位结直肠癌患者支付41,134美元，为每位乳腺癌患者支付20,964美元，与1991年经通胀调整后的增加额分别为7139美元、5345美元和4189美元相对应。在同一时期，2002年前列腺癌初始治疗的平均医疗保险支付下降了196美元，降至18,261美元。所有癌症的任何住院治疗费用在支付费用中占最大比例。1991年至2002年间，所有癌症的化疗使用量均显著增加，放疗使用量也是如此（结直肠癌除外）。2002年这四种癌症初始治疗所需的医疗保险支付总额超过67亿美元，其中结直肠癌和肺癌总体成本最高。
初始癌症治疗成本的统计学显著增加反映出更多患者接受手术和辅助治疗以及这些治疗价格上涨。尽管更有效地针对昂贵治疗可能减轻这一趋势的总体经济影响，但这些趋势在不久的将来可能会持续。
