Policy Analysis Inc PAI, Brookline, MA 02445, USA.
Prostate Cancer Prostatic Dis. 2013 Mar;16(1):23-7. doi: 10.1038/pcan.2012.42. Epub 2012 Nov 13.
Patients with bone metastases secondary to prostate cancer are predisposed to skeletal-related events (SREs), including spinal cord compression, pathological fracture, surgery to bone and radiotherapy to bone. The objective of this study was to document current patterns of healthcare utilization and costs of SREs in patients with prostate cancer and bone metastases.
This was a retrospective, observational study using the Thomson MedStat MarketScan Commercial Claims and Encounters database from September 2002 to June 2011. Study subjects included all persons with claims for prostate cancer and for bone metastases, and one or more claims for an SRE. Unique SRE episodes were identified based on a gap of at least 90 days without an SRE claim, and classified by treatment setting (inpatient or outpatient) and SRE type (spinal cord compression, pathological fracture, surgery to bone or radiotherapy).
Of 3919 patients with prostate cancer and bone metastases, 2090 (53%) had one or more SRE episodes. Among 1237 patients who met all other criteria, there were 1623 SRE episodes over a mean (s.d.) follow-up of 16.1 (12.9) months. The percent of episodes that required inpatient treatment ranged from 14% (radiotherapy) to 82% (surgery to bone). On average, inpatient episodes with surgery to bone (n = 36 episodes) were most costly (mean (s.e.) $88,838 ($11,830)/episode), whereas outpatient episodes with surgery to bone (n = 8 episodes) were least costly (mean (s.e.) $4749 ($1690)/episode). Of the total SRE costs (mean (s.e.) $20,984 ($951)/episode), 41% were attributable to outpatient radiotherapy (n = 1169 episodes), 23% to inpatient radiotherapy (n = 184 episodes), and 19% to inpatient treatment of pathological fractures (n = 101 episodes).
In patients with prostate cancer and bone metastases, SREs are associated with high costs and hospitalizations.
患有前列腺癌骨转移的患者易发生与骨骼相关的事件（SREs），包括脊髓压迫、病理性骨折、骨手术和骨放疗。本研究的目的是记录前列腺癌和骨转移患者 SREs 的当前医疗保健利用和成本模式。
这是一项回顾性、观察性研究，使用了 2002 年 9 月至 2011 年 6 月的 Thomson MedStat MarketScan 商业索赔和就诊数据库。研究对象包括所有有前列腺癌和骨转移索赔的人，以及一个或多个 SRE 索赔的人。根据至少 90 天无 SRE 索赔的间隔，确定独特的 SRE 发作，并按治疗环境（住院或门诊）和 SRE 类型（脊髓压迫、病理性骨折、骨手术或放疗）进行分类。
在 3919 例患有前列腺癌和骨转移的患者中，有 2090 例（53%）发生了一个或多个 SRE 发作。在满足所有其他标准的 1237 例患者中，在平均（标准差）16.1（12.9）个月的随访中，有 1623 例 SRE 发作。需要住院治疗的发作比例从 14%（放疗）到 82%（骨手术）不等。平均而言，骨手术的住院发作（n = 36 例）费用最高（平均（SE）88838 美元（11830 美元）/例），而骨手术的门诊发作（n = 8 例）费用最低（平均（SE）4749 美元（1690 美元）/例）。在总 SRE 成本中（平均（SE）20984 美元（951 美元）/例），41%归因于门诊放疗（n = 1169 例），23%归因于住院放疗（n = 184 例），19%归因于住院治疗病理性骨折（n = 101 例）。
在患有前列腺癌和骨转移的患者中，SREs 与高成本和住院治疗相关。
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