Kansas City Cancer Center, Overland Park, KS; Texas Oncology, Austin; US Oncology, Houston, TX; New York Oncology Hematology, Albany, NY; Aetna Informatics; and Aetna, Hartford, CT.
J Oncol Pract. 2010 Jan;6(1):12-8. doi: 10.1200/JOP.091058. Epub 2009 Dec 30.
The goal of this study was to evaluate the cost-effectiveness of Level I Pathways, a program designed to ensure the delivery of evidence-based care, among patients with non-small-cell lung cancer (NSCLC) treated in the outpatient community setting.
We included patients with NSCLC initiating a chemotherapy regimen between July 1, 2006, and December 31, 2007, at eight practices in the US Oncology network. Patients were characterized with respect to age, sex, stage, performance status, and line of therapy and were classified by whether they were treated according to Level I Pathways guidelines. Twelve-month cost of care and overall survival were compared between patients treated on Pathway and off Pathway. A net monetary benefit approach and corresponding cost-effectiveness acceptability curves were used to evaluate the cost-effectiveness of Level I Pathways.
Overall, outpatient costs were 35% lower for on-Pathway versus off-Pathway patients (average 12-month cost, $18,042 v $27,737, respectively). Costs remained significantly less for patients treated on Pathway versus off Pathway in the adjuvant and first-line settings, whereas no difference in overall cost was observed in patients in the second-line setting. No difference in overall survival was observed overall or by line of therapy. In the net monetary benefit analysis, after adjusting for potential confounders, we found that treating patients on Pathway was cost effective across a plausible range of willingness-to-pay thresholds.
Results of this study suggest that treating patients according to evidence-based guidelines is a cost-effective strategy for delivering care to those with NSCLC.
本研究旨在评估 Level I Pathways 的成本效益，该方案旨在确保在社区门诊环境中治疗非小细胞肺癌（NSCLC）患者时提供基于证据的护理。
我们纳入了 2006 年 7 月 1 日至 2007 年 12 月 31 日期间在美国肿瘤学网络的 8 家诊所中接受化疗方案的 NSCLC 患者。根据年龄、性别、分期、表现状态和治疗线对患者进行特征描述，并根据他们是否按照 Level I Pathways 指南进行治疗进行分类。比较了在 Pathway 治疗和非 Pathway 治疗的患者之间的 12 个月的护理成本和总生存。采用净货币收益方法和相应的成本效益可接受性曲线来评估 Level I Pathways 的成本效益。
总体而言，与非 Pathway 治疗的患者相比，Pathway 治疗的患者门诊费用降低了 35%（平均 12 个月的费用分别为 18042 美元和 27737 美元）。在辅助和一线治疗中，Pathway 治疗的患者的成本仍然明显较低，而在二线治疗中，总体成本没有差异。总体生存或治疗线均未观察到差异。在净货币收益分析中，在调整了潜在的混杂因素后，我们发现，按照指南治疗患者在一系列合理的支付意愿阈值下是具有成本效益的。
这项研究的结果表明，根据循证指南治疗患者是为 NSCLC 患者提供护理的一种具有成本效益的策略。
