Department of Medicine, School of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA..
Prostate. 2010 Aug;70(11):1255-64. doi: 10.1002/pros.21161.
Out-of-pocket and indirect (OPI) costs play an important role in prostate cancer (PCa) outcomes research. We sought to analyze OPI costs of newly diagnosed PCa patients receiving either radical prostatectomy (RP) or external beam radiation therapy (EBRT).
Prospective cohort design was used to recruit 512 newly diagnosed PCa patients from urology clinics of an urban academic hospital and a Veterans Administration medical center. Participants provided demographic information and completed self-reported generic and prostate-specific Health Related Quality of Life (HRQoL) and indirect-cost surveys at baseline and at 3, 6, 12, and 24 months follow-up. Linear mixed models were applied to study the association between OPI costs, treatment and HRQoL outcomes. Propensity scores adjusted for potential confounders and Bonferroni correction was used to account for multiple testing.
Total mean OPI costs varied between RP group and EBRT group at 3-month ($5576 vs. $2010), 6-month ($1776 vs. $2133), 12-month ($757 vs. $774), and at 24-month follow-up ($458 vs. $871). Linear mixed models indicated that RP was associated with lower medication costs (OR = 0.61, CI = 0.48-0.89) and total OPI costs (OR = 0.71, CI = 0.64-0.92). Total OPI costs were inversely related to most of the generic HRQoL items. Similarly, prostate-specific HRQoL items of urinary function (OR = 0.72; adjusted-CI = 0.58-0.84), bowel function (OR = 0.96; adjusted-CI = 0.78-0.98), sexual function (OR = 0.85; adjusted-CI = 0.72-0.92), urinary bother (OR = 0.79; adjusted-CI = 0.67-0.83), and sexual bother (OR = 0.88; adjusted-CI = 0.76-0.93) were inversely related to OPI costs.
OPI costs of PCa care are substantial and vary across time and treatment.
自付和间接（OPI）成本在前列腺癌（PCa）结局研究中起着重要作用。我们旨在分析接受根治性前列腺切除术（RP）或外束放射治疗（EBRT）的新诊断 PCa 患者的 OPI 成本。
前瞻性队列设计招募了 512 名来自城市学术医院泌尿科诊所和退伍军人管理局医疗中心的新诊断 PCa 患者。参与者提供人口统计学信息，并在基线以及 3、6、12 和 24 个月随访时完成了通用和前列腺特异性健康相关生活质量（HRQoL）和间接成本调查。线性混合模型用于研究 OPI 成本、治疗和 HRQoL 结果之间的关联。采用倾向评分调整潜在混杂因素，并使用 Bonferroni 校正法进行多次检验。
RP 组和 EBRT 组在 3 个月（5576 美元对 2010 美元）、6 个月（1776 美元对 2133 美元）、12 个月（757 美元对 774 美元）和 24 个月随访（458 美元对 871 美元）时的总平均 OPI 成本存在差异。线性混合模型表明，RP 与较低的药物成本（OR=0.61，CI=0.48-0.89）和总 OPI 成本（OR=0.71，CI=0.64-0.92）相关。OPI 总成本与大多数通用 HRQoL 指标呈负相关。同样，尿功能（OR=0.72；调整后的 CI=0.58-0.84）、肠功能（OR=0.96；调整后的 CI=0.78-0.98）、性功能（OR=0.85；调整后的 CI=0.72-0.92）、尿困扰（OR=0.79；调整后的 CI=0.67-0.83）和性功能困扰（OR=0.88；调整后的 CI=0.76-0.93）的前列腺特异性 HRQoL 指标也与 OPI 成本呈负相关。
PCa 治疗的 OPI 成本相当可观，并随时间和治疗方式而变化。
