*Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD †Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA ‡Information Management Services. Inc Rockville, MD §Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA ∥Department of Health Policy and Management, Emory University, Atlanta, GA.
Med Care. 2014 Jul;52(7):594-601. doi: 10.1097/MLR.0000000000000151.
Although patient time costs are recommended for inclusion in cost-effectiveness analyses, these data are not routinely collected. We used nationally representative data and a medical service-based approach to estimate the annual patient time costs among cancer survivors.
We identified adult 6699 cancer survivors and 86,412 individuals without a cancer history ages 18 years or more from 2008-2011 Medical Expenditure Panel Survey (MEPS). Service use was categorized as hospitalizations, emergency room use, provider visits, ambulatory surgery, chemotherapy, and radiation therapy. Service time estimates were applied to frequencies for each service category and the US median wage rate in 2011 was used to value time. We evaluated the association between cancer survivorship and service use frequencies and patient time costs with multivariable regression models, stratified by age group (18-64 and 65+ y). Sensitivity analyses evaluated different approaches for valuing time.
Cancer survivors were more likely to have hospitalizations, emergency room visits, ambulatory surgeries, and provider visits in the past year than individuals without a cancer history in adjusted analyses (P<0.05). Annual patient time was higher for cancer survivors than individuals without a cancer history among those aged 18-64 years (30.2 vs. 13.6 h; P<0.001) and 65+ years (55.1 vs. 36.6 h; P<0.001), as were annual patient time costs (18-64 y: $500 vs. $226; P<0.001 and 65+ y: $913 vs. $607; P<0.001).
Cancer survivors had greater annual medical service use and patient time costs than individuals without a cancer history. This medical service-based approach for estimating annual time costs can also be applied to other conditions.
尽管建议将患者时间成本纳入成本效益分析，但这些数据通常并未收集。我们使用全国代表性数据和基于医疗服务的方法来估算癌症幸存者的年度患者时间成本。
我们从 2008-2011 年的医疗支出调查（MEPS）中确定了 6699 名成年癌症幸存者和 86412 名无癌症病史的 18 岁或以上个体。服务使用分为住院、急诊就诊、就诊、门诊手术、化疗和放疗。服务时间估计应用于每个服务类别的频率，2011 年的美国中位数工资率用于评估时间价值。我们使用多变量回归模型评估了癌症生存者与服务使用频率和患者时间成本之间的关联，该模型按年龄组（18-64 岁和 65 岁以上）进行分层。敏感性分析评估了不同的时间估值方法。
在调整后的分析中，癌症幸存者在过去一年中更有可能住院、急诊就诊、门诊手术和就诊，而无癌症病史的个体则没有（P<0.05）。在 18-64 岁年龄组（30.2 小时对 13.6 小时；P<0.001）和 65 岁以上年龄组（55.1 小时对 36.6 小时；P<0.001），癌症幸存者的年度患者时间高于无癌症病史的个体，年度患者时间成本也高于无癌症病史的个体（18-64 岁：500 美元对 226 美元；P<0.001；65 岁以上：913 美元对 607 美元；P<0.001）。
癌症幸存者的年度医疗服务使用和患者时间成本高于无癌症病史的个体。这种基于医疗服务的方法可用于估算年度时间成本，也可应用于其他疾病。
