Department of Medicine, Toronto, ON, Canada (MDK, SMHA, GT, GN).
Faculty of Pharmacy, Toronto, ON, Canada (MDK)
Med Decis Making. 2014 Apr;34(3):366-78. doi: 10.1177/0272989X13493970. Epub 2013 Jul 26.
To obtain estimates of direct health care costs for prostate cancer (PC) from diagnosis to death to inform state transition models.
A stratified random sample of PC patients residing in 3 geographically diverse regions of Ontario, Canada, and diagnosed in 1993-1994, 1997-1998, and 2001-2002, was selected from the Ontario Cancer Registry. We retrieved patients' pathology reports to identify referring physicians and contacted surviving patients and next of kin of deceased patients for informed consent. We reviewed clinic charts to obtain data required to allocate each patient's observation time to 11 PC-specific health states. We linked these data to health care administrative databases to calculate resource use and costs (Canadian dollars, 2008) per health state. A multivariable mixed-effects model determined predictors of costs.
The final sample numbered 829 patients. In the regression model, total direct costs increased with age, comorbidity, and Gleason score (all P < 0.0001). Radical prostatectomy was the most costly primary treatment health state ($4676 per 100 days). Radical prostatectomy, hormone-refractory metastatic disease ($6398 per 100 days), and final (predeath) ($13,739 per 100 days) health states were significantly more costly (P < 0.05) than nontreated nonmetastatic PC ($3440 per 100 days), whereas the postprostatectomy ($732 per 100 days) and postradiation ($1556 per 100 days) states cost significantly less (P < 0.0001).
This study used an innovative but labor-intensive approach linking chart and administrative data to estimate health care costs. Researchers should weigh the potential benefits of this method against what is involved in implementation. Modifications in methodology may achieve similar gains with less outlay in individual studies. However, we believe that this is a promising approach for researchers wishing to advance the quality of costing in state transition modeling.
从诊断到死亡，估计前列腺癌（PC）的直接医疗成本，为状态转移模型提供信息。
从安大略癌症登记处中选择了 1993-1994 年、1997-1998 年和 2001-2002 年在加拿大安大略省 3 个地理位置不同的地区居住并被诊断为 PC 的 PC 患者的分层随机样本。我们检索了患者的病理报告以识别转诊医生，并联系了存活患者和死亡患者的近亲以获得知情同意。我们审查了诊所图表，以获取将每个患者的观察时间分配给 11 个特定于 PC 的健康状态所需的数据。我们将这些数据与医疗保健管理数据库链接起来，以计算每个健康状态的资源使用和成本（2008 年加元）。多变量混合效应模型确定了成本的预测因素。
最终样本数为 829 名患者。在回归模型中，总直接成本随年龄、合并症和 Gleason 评分而增加（均 P <0.0001）。根治性前列腺切除术是最昂贵的主要治疗健康状态（每 100 天 4676 加元）。根治性前列腺切除术、激素难治性转移性疾病（每 100 天 6398 加元）和最终（死亡前）（每 100 天 13739 加元）健康状态的成本明显高于未经治疗的非转移性 PC（每 100 天 3440 加元），而前列腺切除术后（每 100 天 732 加元）和放疗后（每 100 天 1556 加元）的状态成本明显较低（均 P <0.0001）。
本研究使用了一种创新但劳动强度大的方法，将图表和行政数据链接起来以估计医疗保健成本。研究人员应权衡这种方法的潜在好处与实施所涉及的问题。在个别研究中，方法的修改可能会以较少的支出获得类似的收益。但是，我们相信，对于希望提高状态转移模型成本质量的研究人员来说，这是一种很有前途的方法。
