University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA,
Pharmacoeconomics. 2014 Feb;32(2):173-91. doi: 10.1007/s40273-013-0121-y.
Advanced prostate cancer patients with bone metastasis are predisposed to skeletal complications termed skeletal-related events (SREs). There is limited information available on Medicare costs associated with treating SREs. The objective of this study was to ascertain SRE-related costs among older men with metastatic prostate cancer in the US.
We analysed patients aged 66 years or older who were diagnosed with incident stage IV (M1) prostate cancer between 2000 and 2007 from the linked Surveillance, Epidemiology and End Results (SEER)-Medicare dataset. A propensity score for the incidence of an SRE was estimated using a logistic regression model including demographic and clinical baseline variables. Patients with SREs (cases) were matched to patients without SREs (controls) based on the propensity score, length of follow-up (i.e. date of prostate cancer diagnosis to last date of observation) and death. Health resource utilization cost differences between cases and controls over time were compared using generalized linear models. Healthcare costs were examined by type of SRE (pathological fracture only, pathological fracture with concurrent surgery, spinal cord compression only, spinal cord compression with concurrent surgery, and bone surgery only) and by source of care (inpatient, physician/non-institutional provider, skilled nursing facility, outpatient and hospice). All costs were adjusted to 2009 US dollars, using the medical care component of the Consumer Price Index.
Application of the inclusion criteria resulted in 1,131 metastatic prostate cancer patients with SREs and 6,067 patients without SREs during follow-up. The average age of the sample was 79 years, and 14 % were African American. A total of 928 patients with SREs were matched to 928 patients without SREs. The average health care utilization cost of patients with SREs was US$29,696 (95 % confidence interval [CI] US$24,730-US$34,662) higher than that of the controls. The most expensive SRE group was spinal cord compression with concurrent surgery (US$82,868: 95 % CI US$67,472-US$98,264) followed by bone surgery only (US$37,496: 95 % CI US$29,684-US$45,308), pathological fracture with concurrent surgery (US$34,169: 95 % CI US$25,837-US$ 42,501), spinal cord compression only (US$25,793: 95 % CI US$20,933-US$30,653) and pathological fracture only (US$14,649: 95 % CI US$6,537-US$22,761). The largest cost difference by source of care was observed for hospitalizations (p < 0.01).
Metastatic prostate cancer patients with SREs incur higher costs compared to similar patients without SREs. SRE costs among older stage IV (M1) prostate cancer patients vary by SRE type, with spinal cord compression and concurrent surgery costing at least twice as much as other SREs.
患有骨转移的晚期前列腺癌患者易发生骨骼相关并发症，称为骨骼相关事件（SREs）。关于治疗 SREs 相关的医疗保险费用的信息有限。本研究的目的是确定美国转移性前列腺癌老年患者的 SRE 相关费用。
我们分析了 2000 年至 2007 年间，来自链接的监测、流行病学和最终结果（SEER）-医疗保险数据集的年龄在 66 岁或以上且被诊断患有 IV 期（M1）前列腺癌的患者。使用逻辑回归模型，包括人口统计学和临床基线变量，估计 SRE 发生率的倾向评分。根据倾向评分、随访时间（即前列腺癌诊断日期至最后观察日期）和死亡情况，将发生 SRE 的患者（病例）与未发生 SRE 的患者（对照组）匹配。使用广义线性模型比较病例和对照组随时间推移的健康资源利用成本差异。通过 SRE 的类型（仅病理性骨折、病理性骨折伴手术、脊髓压迫仅、脊髓压迫伴手术、骨手术仅）和护理来源（住院、医生/非机构提供者、熟练护理设施、门诊和临终关怀）检查医疗费用。所有成本均使用消费者物价指数的医疗保健部分调整为 2009 年美元。
应用纳入标准后，在随访期间，1131 名转移性前列腺癌患者发生 SRE，6067 名患者未发生 SRE。样本的平均年龄为 79 岁，14%为非裔美国人。共有 928 名 SRE 患者与 928 名无 SRE 患者匹配。SRE 患者的平均医疗保健利用成本比对照组高 29696 美元（95%置信区间：24730 美元至 34662 美元）。最昂贵的 SRE 组是脊髓压迫伴手术（82868 美元：95%置信区间：67472 美元至 98264 美元），其次是仅骨手术（37496 美元：95%置信区间：29684 美元至 45308 美元）、病理性骨折伴手术（34169 美元：95%置信区间：25837 美元至 42501 美元）、脊髓压迫仅（25793 美元：95%置信区间：20933 美元至 30653 美元）和仅病理性骨折（14649 美元：95%置信区间：6537 美元至 22761 美元）。在护理来源方面，观察到住院治疗的费用差异最大（p < 0.01）。
与无 SRE 的类似患者相比，患有 SRE 的转移性前列腺癌患者的成本更高。IV 期（M1）前列腺癌老年患者的 SRE 成本因 SRE 类型而异，脊髓压迫和手术治疗的费用至少是其他 SRE 的两倍。
