Policy Analysis Inc (PAI), Brookline, MA, USA.
BMC Cancer. 2011 Jun 15;11:250. doi: 10.1186/1471-2407-11-250.
The economic costs of treating patients with metastatic breast cancer have been examined in several studies, but available estimates of economic burden are at least a decade old. In this study, we characterize healthcare utilization and costs in the US among women with metastatic breast cancer receiving chemotherapy as their principal treatment modality.
Using a large private health insurance claims database (2000-2006), we identified all women initiating chemotherapy for metastatic breast cancer with no evidence of receipt of concomitant or subsequent hormonal therapy, or receipt of trastuzumab at anytime. Healthcare utilization and costs (inpatient, outpatient, medication) were estimated on a cumulative basis from date of chemotherapy initiation ("index date") to date of disenrollment from the health plan or the end of the study period, whichever occurred first. Study measures were cumulated over time using the Kaplan-Meier Sample Average (KMSA) method; 95% CIs were generated using nonparametric bootstrapping. Findings also were examined among the subgroup of patients with uncensored data.
The study population consisted of 1444 women; mean (SD) age was 59.1 (12.1) years. Over a mean follow-up of 532 days (range: 3 to 2412), study subjects averaged 1.7 hospital admissions, 10.7 inpatient days, and 83.6 physician office and hospital outpatient visits. Mean (95% CI) cumulative total healthcare costs were $128,556 ($118,409, $137,644) per patient. Outpatient services accounted for 29% of total costs, followed by medication other than chemotherapy (26%), chemotherapy (25%), and inpatient care (20%).
Healthcare costs-especially in the outpatient setting--are substantial among women with metastatic breast cancer for whom treatment options other than chemotherapy are limited.
已有多项研究考察了转移性乳腺癌患者的治疗经济成本，但现有的经济负担估计至少有十年的历史了。本研究旨在描述美国转移性乳腺癌女性患者的化疗主要治疗模式下的医疗保健利用和成本情况。
利用一个大型私人健康保险索赔数据库（2000-2006 年），我们确定了所有接受化疗治疗转移性乳腺癌且无同时或随后接受激素治疗或任何时候接受曲妥珠单抗治疗证据的女性。从化疗开始日期（“索引日期”）到健康计划退保或研究期结束（以先发生者为准），按累计基础估算医疗保健的使用和成本（住院、门诊、药物）。使用 Kaplan-Meier 样本平均（KMSA）法随时间累积研究指标；使用非参数自举法生成 95%置信区间。还在未删失数据的患者亚组中检查了研究结果。
研究人群包括 1444 名女性；平均（标准差）年龄为 59.1（12.1）岁。在平均 532 天（范围：3 至 2412 天）的随访中，研究对象平均有 1.7 次住院、10.7 天住院和 83.6 次医生办公室和医院门诊就诊。每位患者的平均（95%CI）累计总医疗保健费用为 128556 美元（118409 美元，137644 美元）。门诊服务占总费用的 29%，其次是化疗以外的药物（26%）、化疗（25%）和住院护理（20%）。
对于化疗以外的治疗选择有限的转移性乳腺癌女性患者，医疗保健费用（尤其是门诊费用）相当高。
