OptumInsight , Eden Prairie, MN , USA.
J Med Econ. 2013 Dec;16(12):1379-86. doi: 10.3111/13696998.2013.848208. Epub 2013 Oct 18.
Pancreatic adenocarcinoma has few effective treatment options and poor survival. The objective of this study was to characterize treatment patterns and estimate the costs and resource use associated with its treatment in a commercially-insured US population.
In this retrospective claims-based analysis, individuals ≥18 years old with evidence of pancreatic adenocarcinoma between January 1, 2001 and December 31, 2010 were selected from a managed care database. Treatment phase (either initial non-metastatic or metastatic) was determined using a claims-based algorithm. Patients in the pancreatic cancer population were matched 1:3 to a control population. Resource use (events/person-years), treatment patterns, and healthcare costs (per-patient per-month, PPPM) were determined during a variable length follow-up period (from first pancreatic cancer diagnosis to earliest of death, disenrollment, or study end).
In this study, 5262 pancreatic cancer patients were matched to 15,786 controls. Rates of office visits, inpatient visits, ER visits, and inpatient stays, and mean total all-cause healthcare costs PPPM ($15,480 vs $1001) were significantly higher among cancer patients than controls (all p < 0.001). Mean inpatient costs were the single largest cost driver ($9917 PPPM). Also, mean total all-cause healthcare costs were significantly higher during the metastatic treatment phase vs the initial treatment phase of non-metastatic disease ($21,637 vs $10,358, p < 0.001).
These results indicate that pancreatic cancer imposes a substantial burden on the US healthcare system, and that treatment of more advanced disease is significantly more costly than initial treatment of non-metastatic disease.
Additional research is needed to validate the accuracy of the claims-based algorithms used to identify the treatment phase.
胰腺腺癌治疗选择有限，生存预后差。本研究旨在分析美国商业保险人群胰腺腺癌的治疗模式，并评估其治疗的费用和资源利用情况。
本回顾性基于理赔的分析，从管理式医疗数据库中选取了 2001 年 1 月 1 日至 2010 年 12 月 31 日期间≥18 岁且有胰腺腺癌证据的个体。采用基于理赔的算法确定治疗阶段（初始非转移性或转移性）。将胰腺癌患者按 1：3 与对照组进行匹配。在可变随访期（从首次诊断为胰腺癌到最早死亡、退保或研究结束）内，确定资源利用（事件/人年）、治疗模式和医疗保健费用（每患者每月，PPPM）。
本研究中，5262 例胰腺癌患者与 15786 例对照组相匹配。癌症患者的就诊次数、住院次数、急诊就诊次数和住院天数以及平均总全因医疗保健费用 PPPM（15480 美元比 1001 美元）显著高于对照组（均 p<0.001）。住院费用是最大的成本驱动因素（9917 美元 PPPM）。此外，转移性疾病治疗阶段的总全因医疗保健费用显著高于非转移性疾病的初始治疗阶段（21637 美元比 10358 美元，p<0.001）。
这些结果表明，胰腺腺癌给美国医疗保健系统带来了巨大负担，且晚期疾病的治疗费用明显高于非转移性疾病的初始治疗。
需要进一步的研究来验证用于识别治疗阶段的基于理赔算法的准确性。
