Nonzee Narissa J, Dandade Neal A, Patel Urjeet, Markossian Talar, Agulnik Mark, Argiris Athanassios, Patel Jyoti D, Kern Robert C, Munshi Hidayatullah G, Calhoun Elizabeth A, Bennett Charles L
Robert H. Lurie Comprehensive Cancer Center and Division of Hematology/Oncology, Northwestern University, Chicago, Illinois 60611, USA.
Cancer. 2008 Sep 15;113(6):1446-52. doi: 10.1002/cncr.23714.
Few studies have examined the costs of supportive care for radiochemotherapy-induced mucosits/pharyngitis among patients with head and neck cancer (HNC) or lung cancers despite the documented negative clinical impact of these complications.
The authors identified a retrospective cohort of patients with HNC or nonsmall lung cancer (NSCLC) who had received radiochemotherapy at 1 of 3 Chicago hospitals (a Veterans Administration hospital, a county hospital, or a tertiary care hospital). Charts were reviewed for the presence/absence of severe mucositis/pharyngitis and the medical resources that were used. Resource estimates were converted into cost units obtained from standard sources (hospital bills, Medicare physician fee schedule, Red Book). Estimates of resources used and direct medical costs were compared for patients who did and patients who did not develop severe mucositis/pharyngitis.
Severe mucositis/pharyngitis occurred in 70.1% of 99 patients with HNC and in 37.5% of 40 patients with NSCLC during radiochemotherapy. The total median medical costs per patient were USD 39,313 for patients with mucositis/pharyngitis and USD 20,798 for patients without mucositis/pharyngitis (P = .007). Extended inpatient hospitalization accounted for USD 12,600 of the increased medical costs (median 14 days [USD 19,600] with severe mucositis/pharyngitis vs 5 days [USD 7,000] without; P = .017). For patients who had HNC with mucositis/pharyngitis, incremental inpatient hospitalization costs were USD 14,000, and total medical costs were USD 17,244. For patients who had NSCLC with mucositis/pharyngitis, these costs were USD 11,200 and USD 25,000, respectively.
In the current study, the medical costs among the patients with HNC and NSCLC who received radiochemotherapy were greater for those who developed severe mucositis/pharyngitis than for those who did not.
尽管有文献记载这些并发症对临床有负面影响,但很少有研究探讨头颈部癌(HNC)或肺癌患者放化疗引起的粘膜炎/咽炎的支持性护理成本。
作者确定了一组在芝加哥3家医院(一家退伍军人管理局医院、一家县医院或一家三级护理医院)之一接受放化疗的HNC或非小细胞肺癌(NSCLC)患者的回顾性队列。查阅病历以确定是否存在严重粘膜炎/咽炎以及所使用的医疗资源。资源估计数被转换为从标准来源(医院账单、医疗保险医师收费表、《红皮书》)获得的成本单位。比较了发生和未发生严重粘膜炎/咽炎的患者的资源使用估计数和直接医疗成本。
在放化疗期间,99例HNC患者中有70.1%发生严重粘膜炎/咽炎,40例NSCLC患者中有37.5%发生严重粘膜炎/咽炎。粘膜炎/咽炎患者的人均总医疗成本中位数为39,313美元,无粘膜炎/咽炎患者为20,798美元(P = 0.007)。延长住院时间导致医疗成本增加12,600美元(严重粘膜炎/咽炎患者中位数为14天[19,600美元],无严重粘膜炎/咽炎患者为5天[7,000美元];P = 0.017)。对于患有粘膜炎/咽炎的HNC患者,住院费用增加14,000美元,总医疗成本为17,244美元。对于患有粘膜炎/咽炎的NSCLC患者,这些成本分别为11,200美元和25,000美元。
在本研究中,接受放化疗的HNC和NSCLC患者中,发生严重粘膜炎/咽炎的患者的医疗成本高于未发生严重粘膜炎/咽炎的患者。