Texas Oncology, Austin; US Oncology, The Woodlands, TX; Ocala Oncology Center, Ocala, FL; New York Oncology Hematology, Albany; Milliman, New York, NY; Kansas City Cancer Center, Overland Park, KS.
J Oncol Pract. 2011 May;7(3 Suppl):52s-9s. doi: 10.1200/JOP.2011.000318.
The goal of this study was to use two separate databases to evaluate the clinical outcomes and the economic impact of adherence to Level I Pathways, an evidence-based oncology treatment program in the treatment of colon cancer.
The first study used clinical records from an electronic health record (EHR) database to evaluate survival according to pathway status in patients with colon cancer. Disease-free survival in patients receiving adjuvant treatment and overall survival in patients receiving first-line therapy for metastatic disease was calculated. The second study used claims data from a national administrative claims database to examine direct medical costs and use, including the cost of chemotherapy and of chemotherapy-related hospitalizations according to pathway status.
Overall costs from the national claims database-including total cost per case and chemotherapy costs-were lower for patients treated according to Level I Pathways (on-Pathway) compared with patients not treated according to Level I Pathways. Use of pathways was also associated with a shorter duration of therapy and lower rate of chemotherapy-related hospital admissions. Survival for patients on-Pathway in the EHR database was comparable with those in the published literature.
Results from two distinct databases suggest that treatment of patients with colon cancer on-Pathway costs less; use of these pathways demonstrates clinical outcomes consistent with published evidence.
本研究旨在使用两个独立的数据库来评估遵循循证肿瘤治疗方案——I 级路径的临床结局和经济影响，该方案用于治疗结肠癌。
第一项研究使用电子病历（EHR）数据库中的临床记录，根据结肠癌患者的路径状态评估生存情况。计算接受辅助治疗的患者无病生存率和接受转移性疾病一线治疗的患者总生存率。第二项研究使用全国行政索赔数据库中的索赔数据，根据路径状态检查直接医疗成本和使用情况，包括化疗成本和与化疗相关的住院费用。
来自全国索赔数据库的总体成本——包括每个病例的总成本和化疗成本——与未按 I 级路径治疗的患者相比，按 I 级路径治疗的患者更低。路径的使用还与治疗时间更短和化疗相关住院率更低相关。EHR 数据库中按路径治疗的患者的生存情况与已发表文献中的相似。
来自两个不同数据库的结果表明，按路径治疗结肠癌患者的成本更低；这些路径的使用表明与已发表证据一致的临床结局。
