Division of Outcomes Research and Quality, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA; Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA.
Surgery. 2013 Dec;154(6):1363-9; discussion 1369-70. doi: 10.1016/j.surg.2013.06.042. Epub 2013 Aug 22.
Little is known about costs associated with differentiated thyroid cancer (DTC) and follow-up care. This study used data from the Surveillance Epidemiology and End Results (SEER) database to examine cumulative costs attributable to disease stage and treatment options of DTC in elderly patients over 5 years.
We identified 2,823 patients aged >65 years with DTC and 5,646 noncancer comparison cases from SEER Medicare data between 1995 and 2005. Cumulative costs were obtained by estimating average costs/patient in each month up to 60 months after diagnosis. We performed multivariate analyses of costs by fitting each monthly cost to linear models, controlling for demographics and comorbidities. Marginal effects of covariates were obtained by summing coefficients over 60 months.
Cumulative costs were $17,669/patient the first year and $48,989/patient 5 years after diagnosis. Regional disease was associated with higher costs at 1 year ($9,578) and 5 years ($8,902). Distant disease was associated with 1-year costs of $28,447 and 5-year costs of $20,103. Patients undergoing surgery and radiation had a decrease in cost of $722 at 5 years.
DTC in the elderly is associated with significant economic burden largely attributable to patient demographics, stage of disease, and treatment modalities.
关于分化型甲状腺癌（DTC）及其随访护理相关的费用知之甚少。本研究利用监测、流行病学和最终结果（SEER）数据库的数据，考察了 5 年内老年患者疾病分期和治疗选择与 DTC 相关的累计成本。
我们从 1995 年至 2005 年 SEER 医疗保险数据中确定了 2823 名年龄>65 岁的 DTC 患者和 5646 名非癌症对照病例。通过估计每个月每个患者的平均费用，获得了 60 个月后诊断的累积成本。我们通过将每个月的成本拟合到线性模型中，控制人口统计学和合并症，对成本进行了多变量分析。通过在 60 个月内对协变量的系数求和，获得了协变量的边际效应。
第一年患者的累积费用为 17669 美元/人，第五年为 48989 美元/人。局部疾病在第 1 年（9578 美元）和第 5 年（8902 美元）与更高的费用相关。远处疾病与第 1 年的费用 28447 美元和第 5 年的费用 20103 美元相关。接受手术和放疗的患者在第 5 年的费用减少了 722 美元。
老年人的 DTC 与重大的经济负担相关，主要归因于患者的人口统计学、疾病分期和治疗方式。
