Toronto General Research Institute, Toronto General Hospital, Toronto, ON. ; Department of Medicine, Toronto General Hospital, Toronto, ON. ; Faculty of Pharmacy, University of Toronto, Toronto, ON. ; Department of Medicine, University of Toronto, Toronto, ON. ; Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON. ; Institute for Clinical Evaluative Sciences, Toronto, ON.
Toronto General Research Institute, Toronto General Hospital, Toronto, ON. ; Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON.
Curr Oncol. 2014 Jun;21(3):e457-65. doi: 10.3747/co.21.1865.
Serious adverse events have been associated with androgen deprivation therapy (adt) for prostate cancer (pca), but few studies address the costs of those events.
All pca patients (ICD-9-CM 185) in Ontario who started 90 days or more of adt or had orchiectomy at the age of 66 or older during 1995-2005 (n = 26,809) were identified using the Ontario Cancer Registry and drug and hospital data. Diagnosis dates of adverse events-myocardial infarction, acute coronary syndrome, congestive heart failure, stroke, deep vein thrombosis or pulmonary embolism, any diabetes, and fracture or osteoporosis-before and after adt initiation were determined from administrative data. We excluded patients with the same diagnosis before and after adt, and we allocated each patient's time from adt initiation to death or December 31, 2007, into health states: adt (no adverse event), adt-ae (specified single adverse event), Multiple (>1 event), and Final (≤180 days before death). We used methods for Canadian health administrative data to estimate annual total health care costs during each state, and we examined monthly trends.
Approximately 50% of 21,811 patients with no pre-adt adverse event developed 1 or more events after adt. The costliest adverse event state was stroke ($26,432/year). Multiple was the most frequent (n = 2,336) and the second most costly health state ($24,374/year). Costs were highest in the first month after diagnosis (from $1,714 for diabetes to $14,068 for myocardial infarction). Costs declined within 18 months, ranging from $784 per 30 days (diabetes) to $1,852 per 30 days (stroke). Adverse events increased the costs of adt by 100% to 265%.
The economic burden of adverse events is relevant to programs and policies from clinic to government, and that burden merits consideration in the risks and benefits of adt.
雄激素剥夺疗法（ADT）治疗前列腺癌（PCA）会引发严重不良事件，但很少有研究涉及这些事件的成本。
使用安大略癌症登记处以及药物和医院数据，确定了 1995 年至 2005 年期间年龄在 66 岁或以上、开始接受 ADT 治疗 90 天或以上或接受睾丸切除术的所有 PCA 患者（ICD-9-CM 185）（n=26809）。使用行政数据确定 ADT 开始前后的不良事件（心肌梗死、急性冠状动脉综合征、充血性心力衰竭、中风、深静脉血栓形成或肺栓塞、任何糖尿病以及骨折或骨质疏松症）的诊断日期。我们排除了 ADT 前后具有相同诊断的患者，并将每位患者从 ADT 开始到死亡或 2007 年 12 月 31 日的时间分配到以下健康状态：ADT（无不良事件）、ADT-AE（指定的单一不良事件）、多种（>1 种事件）和最终（≤180 天前死亡）。我们使用加拿大卫生行政数据的方法来估算每个状态的年度总医疗保健费用，并检查了每月的趋势。
大约 50%的 21811 名无 ADT 前不良事件的患者在 ADT 后出现了 1 种或多种不良事件。最昂贵的不良事件状态是中风（每年 26432 美元）。多种是最常见的（n=2336），也是第二昂贵的健康状态（每年 24374 美元）。诊断后的第一个月费用最高（从糖尿病的 1714 美元到心肌梗死的 14068 美元）。在 18 个月内，费用下降了，范围从 30 天 784 美元（糖尿病）到 30 天 1852 美元（中风）。不良事件使 ADT 的成本增加了 100%至 265%。
不良事件的经济负担与诊所到政府的计划和政策相关，这一负担值得在 ADT 的风险和收益中加以考虑。
