Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
J Urol. 2010 Apr;183(4):1504-9. doi: 10.1016/j.juro.2009.12.014. Epub 2010 Feb 20.
Surgical treatment for prostate cancer represents a large national health care expenditure. We determined whether state level variation in the cost of radical prostatectomy exists and whether we could explain this variation by adjusting for covariates associated with cost.
Using the 2004 Healthcare Cost and Utilization Project National Inpatient Sample of 7,978,041 patients we identified 9,917 who were 40 years old or older with a diagnosis of prostate cancer who underwent radical prostatectomy without cystectomy. We used linear regression to examine state level regional variation in radical prostatectomy costs, controlling for the local area wage index, patient demographics, case mix and hospital characteristics.
The mean +/- SD unadjusted cost was $9,112 +/- $4,434 (range $2,001 to $49,922). The unadjusted mean cost ranged from $12,490 in California to $4,650 in Utah, each significantly different from the mean of $8,903 in the median state, Washington (p <0.0001). After adjusting for all potential confounders total cost was highest in Colorado and lowest in New Jersey, which were significantly different from the median, Washington ($10,750 and $5,899, respectively, vs $8,641, p <0.0001). The model explained 85.9% of the variance with regional variation accounting for the greatest incremental proportion of variance (35.1%) and case mix variables accounting for an incremental 32.3%.
The total cost of radical prostatectomy varies significantly across states. Controlling for known total cost determinants did not completely explain these differences but altered ordinal cost relationships among states. Cost variation suggests inefficiencies in the health care market. Additional studies are needed to determine whether these variations in total cost translate into differences in quality or outcome and how they may be translated into useful policy measures.
前列腺癌的外科治疗代表了巨大的国家卫生保健支出。我们确定是否存在根治性前列腺切除术的州际费用差异，以及通过调整与费用相关的协变量，是否可以解释这种差异。
使用 2004 年医疗保健成本和利用项目全国住院患者样本中的 7978041 名患者，我们确定了 9917 名 40 岁或以上的前列腺癌患者，他们没有接受过根治性前列腺切除术，也没有接受过根治性前列腺切除术。我们使用线性回归分析来检查根治性前列腺切除术费用的州际区域差异，控制当地工资指数、患者人口统计学、病例组合和医院特征。
未经调整的平均费用为 9112 美元 4434 美元（范围 2001 美元至 49922 美元）。未经调整的平均费用从加利福尼亚州的 12490 美元到犹他州的 4650 美元不等，每个州都与中位数为 8903 美元的华盛顿州显著不同（p<0.0001）。在调整了所有潜在混杂因素后，科罗拉多州的总费用最高，新泽西州的总费用最低，与中位数为 8641 美元的华盛顿州相比，差异显著（分别为 10750 美元和 5899 美元，p<0.0001）。该模型解释了 85.9%的方差，其中区域差异占方差的最大增量比例（35.1%），病例组合变量占增量的 32.3%。
根治性前列腺切除术的总费用在各州之间差异显著。控制已知的总费用决定因素并不能完全解释这些差异，但改变了各州之间的有序费用关系。成本差异表明医疗保健市场存在效率低下的情况。需要进一步研究以确定这些总成本差异是否转化为质量或结果的差异，以及如何将这些差异转化为有用的政策措施。
