*Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; †Department of Health Policy and Administration, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; ‡Department of Medicine, Duke University School of Medicine, Durham, North Carolina; §Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina; and ‖Department of Radiology, Duke University School of Medicine, Durham, North Carolina.
J Thorac Oncol. 2014 Apr;9(4):512-8. doi: 10.1097/JTO.0000000000000102.
Treatment patterns and cost implications of increased positron emission tomography imaging use since Medicare approval in 1998 are not well understood. We examined rates of surgery, radiotherapy, and chemotherapy and inpatient and total health care costs between 1998 and 2005 among Medicare beneficiaries with non-small-cell lung cancer.
Patients in this retrospective cohort study were 51,374 Medicare beneficiaries diagnosed with non-small-cell lung cancer between 1996 and 2005. The main outcome measures were receipt of surgical resection, radiotherapy, and chemotherapy and inpatient and total health care costs within 1 year of diagnosis.
Between 1996-1997 and 2004-2005, the proportion of patients undergoing surgical resection decreased from 29% to 25%, the proportion receiving radiation therapy decreased from 49% to 43%, and inpatient costs decreased from $28,900 to $26,900. The proportion of patients receiving chemotherapy increased from 25% to 40% and total costs increased from $47,300 to $52,200 (p < 0.001 for all comparisons). Changes in use and costs remained after adjustment for shifting demographic characteristics during the study period.
Adoption of positron emission tomography between 1998 and 2005 was accompanied by decreases in rates of surgery and radiotherapy and in short-term inpatient costs among Medicare beneficiaries with non-small-cell lung cancer, although there was an increase in chemotherapy and overall costs.
自 1998 年医疗保险批准以来，正电子发射断层扫描成像使用的增加所带来的治疗模式和成本影响尚不清楚。我们研究了在 1998 年至 2005 年间，医疗保险受益人与非小细胞肺癌相关的手术、放疗和化疗率以及住院和总医疗保健费用。
本回顾性队列研究的患者为 51374 名在 1996 年至 2005 年间被诊断为非小细胞肺癌的医疗保险受益。主要观察指标为诊断后一年内接受手术切除、放疗和化疗以及住院和总医疗保健费用的情况。
在 1996-1997 年至 2004-2005 年期间，接受手术切除的患者比例从 29%降至 25%，接受放疗的患者比例从 49%降至 43%，住院费用从 28900 美元降至 26900 美元。接受化疗的患者比例从 25%增至 40%，总费用从 47300 美元增至 52200 美元（所有比较均为 p<0.001）。在研究期间，调整人口统计学特征的变化后，使用和成本的变化仍然存在。
在 1998 年至 2005 年间，正电子发射断层扫描的应用伴随着医疗保险受益人与非小细胞肺癌相关的手术和放疗率下降，以及短期住院费用下降，尽管化疗和总体费用增加。
