Pharmerit North America LLC , Bethesda, MD , USA.
J Med Econ. 2013 Oct;16(10):1169-78. doi: 10.3111/13696998.2013.826228. Epub 2013 Aug 19.
To compare the indirect costs of productivity loss between metastatic breast cancer (MBC) and early stage breast cancer (EBC) patients, as well as their respective family members.
The MarketScan Health and Productivity Management database (2005-2009) was used. Adult BC patients eligible for employee benefits of sick leave and/or short-term disability were identified with ICD-9 codes. Difference in sick leave and short-term disability days was calculated between MBC patients and their propensity score matched EBC cohort and general population (controls) during a 12-month follow-up period. Generalized linear models were used to examine the impact of MBC on indirect costs to patients and their families.
A total of 139 MBC, 432 EBC, and 820 controls were eligible for sick leave and 432 MBC, 1552 EBC, and 4682 controls were eligible for short-term disability (not mutually exclusive). After matching, no statistical difference was found in sick leave days and the associated costs between MBC and EBC cohorts. However, MBC patients had significantly higher short-term disability costs than EBC patients and controls (MBC: $6166 ± $9194 vs. EBC: $3690 ± $6673 vs.
$558 ± $2487, both p < 0.001). MBC patients had more sick leave cost than controls ($2383 ± $5539 vs. $1282 ± $2083, p < 0.05). Controlling for covariates, MBC patients incurred 47% more short-term disability costs vs EBC patients (p = 0.009). Older patients (p = 0.002), non-HMO payers (p < 0.05), or patients not receiving chemotherapy during follow-up (p < 0.001) were associated with lower short-term disability costs. MBC patients' families incurred 39.7% (p = 0.06) higher indirect costs compared to EBC patients' families after controlling for key covariates.
Productivity loss and associated costs in MBC patients are substantially higher than EBC patients or the general population. These findings underscore the economic burden of MBC from a US societal perspective. Various treatment regimens should be evaluated to identify opportunities to reduce the disease burden from the societal perspective.
比较转移性乳腺癌（MBC）和早期乳腺癌（EBC）患者以及他们各自的家庭成员的生产力损失的间接成本。
使用 MarketScan 健康和生产力管理数据库（2005-2009 年）。使用 ICD-9 代码识别符合员工病假和/或短期残疾福利资格的成年 BC 患者。在 12 个月的随访期间，计算 MBC 患者与其倾向评分匹配的 EBC 队列和一般人群（对照组）之间的病假和短期残疾天数差异。使用广义线性模型检查 MBC 对患者及其家属间接成本的影响。
共有 139 名 MBC、432 名 EBC 和 820 名对照组符合病假条件，432 名 MBC、1552 名 EBC 和 4682 名对照组符合短期残疾条件（非互斥）。匹配后，MBC 和 EBC 队列之间的病假天数和相关成本没有统计学差异。然而，MBC 患者的短期残疾费用明显高于 EBC 患者和对照组（MBC：$6166 ± $9194 vs. EBC：$3690 ± $6673 vs. 对照组：$558 ± $2487，均 p < 0.001）。MBC 患者的病假费用高于对照组（MBC：$2383 ± $5539 vs. $1282 ± $2083，p < 0.05）。控制协变量后，MBC 患者的短期残疾费用比 EBC 患者高 47%（p = 0.009）。年龄较大的患者（p = 0.002）、非 HMO 支付者（p < 0.05）或在随访期间未接受化疗的患者（p < 0.001）与较低的短期残疾费用相关。在控制关键协变量后，与 EBC 患者的家庭相比，MBC 患者的家庭间接成本增加了 39.7%（p = 0.06）。
MBC 患者的生产力损失和相关成本明显高于 EBC 患者或一般人群。这些发现从美国社会角度强调了 MBC 的经济负担。应评估各种治疗方案，以从社会角度确定减少疾病负担的机会。
