HealthMetrics Outcomes Research, Groton, CT 06340, USA.
J Med Econ. 2010;13(4):691-7. doi: 10.3111/13696998.2010.531829. Epub 2010 Nov 11.
This study examines costs for postmenopausal women with hormone receptor positive (HR+) metastatic breast cancer (mBC).
Data were obtained from the IHCIS National Managed Care Benchmark Database from 1/1/2001 to 6/30/2006. Women aged 55-63 years were selected for the study if they met the inclusion criteria, including diagnoses for breast cancer and metastases, and at least two fills for a hormone medication. Patients were followed from the onset of metastases until the earliest date of disenrollment from the health plan or 6/30/2006. Patient characteristics were examined at time of initial diagnoses of metastases, while costs were examined post-diagnosis of metastases and prior to receipt of chemotherapy (pre-chemotherapy initiation period) and from the date of initial receipt of chemotherapy until end of data collection (post-chemotherapy initiation period). Costs were adjusted to account for censoring of the data.
The study population consisted of 1,266 women; mean (SD) age was 59.05 (2.57) years. Pre-chemotherapy initiation, unadjusted inpatient, outpatient, and drug costs were $4,392, $47,731, and $5,511, while these costs were $4,590, $57,820, and $38,936 per year, respectively, post-chemotherapy initiation. After adjusting for censoring of data, total medical costs were estimated to be $55,555 and $70,587 in the first 12 months and 18 months, respectively in the pre-chemotherapy initiation period. Post-chemotherapy initiation period, 12-month and 18-month adjusted total medical costs were estimated to be $87,638 and $130,738.
The use of an administrative claims database necessitates a reliance upon diagnostic codes, age restrictions, and medication use, rather than formal assessments to identify patients with post-hormonal women with breast cancer. Furthermore, such populations of insured patients may not be generalizable to the population as a whole.
These findings suggest that healthcare resource use and costs - especially in the outpatient setting - are high among women with HR+ metastatic breast cancer.
本研究考察了激素受体阳性（HR+）转移性乳腺癌（mBC）绝经后女性的成本。
数据来自 IHCIS 国家管理式医疗基准数据库，时间范围为 2001 年 1 月 1 日至 2006 年 6 月 30 日。选择年龄在 55-63 岁之间、符合纳入标准的女性，包括乳腺癌和转移的诊断，以及至少两种激素药物的用药记录。患者从转移的起始时间开始进行随访，直至最早的退出健康计划日期或 2006 年 6 月 30 日。在转移的初始诊断时检查患者特征，在转移后诊断时以及在接受化疗之前（化疗起始前期间）和从接受化疗的初始日期到数据收集结束时（化疗起始后期间）检查成本。调整了数据的删失。
研究人群包括 1266 名女性；平均（标准差）年龄为 59.05（2.57）岁。化疗起始前，未经调整的住院、门诊和药物费用分别为 4392 美元、47731 美元和 5511 美元，而化疗起始后分别为 4590 美元、57820 美元和 38936 美元/年。调整数据删失后，化疗起始前 12 个月和 18 个月的总医疗费用估计分别为 55555 美元和 70587 美元。化疗起始后 12 个月和 18 个月的调整总医疗费用估计分别为 87638 美元和 130738 美元。
使用行政索赔数据库需要依赖诊断代码、年龄限制和药物使用，而不是通过正式评估来确定接受激素治疗的女性乳腺癌患者。此外，这类参保患者群体可能不具有普遍性。
这些发现表明，HR+转移性乳腺癌女性的医疗资源使用和成本很高，尤其是在门诊环境中。
