Mahar Alyson L, Coburn Natalie G, Johnson Ana P
Department of Public Health Sciences, Queen's University, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Ontario, Canada; Odette Cancer Centre, Division of General Surgery, Sunnybrook Health Sciences Centre, Ontario, Canada.
Lung Cancer. 2014 Nov;86(2):281-7. doi: 10.1016/j.lungcan.2014.09.013. Epub 2014 Sep 20.
Surgical resection and adjuvant chemotherapy have become standard of care for treating resectable early stage non-small cell lung cancer (NSCLC). The purpose was to describe and compare the overall and regional resource utilization and costs of resected NSCLC treated with and without adjuvant chemotherapy.
MATERIALS & METHODS: A population-based retrospective cohort study of resected NSCLC patients, diagnosed between 2004 and 2006 (representing the cohort immediately affected by the change in clinical practice) was performed using administrative data. Patients were followed for four years from the date of surgery. The healthcare system perspective was used, and cost estimates (2012 US$) were derived from administrative data and the literature.
3354 patients were included. The average cost per patient treated with surgery and adjuvant chemotherapy was $37,860.88 and was significantly higher than the average cost per patient treated with surgery alone $32,221.45 (p<0.0001). Among regions, the costs of patients treated with surgery and chemotherapy ($32,672-$45,453) and the costs of those treated with surgery alone ($28,679-$36,845) varied significantly (p<0.0001). Rates of chemotherapy, the proportion of patients who received any imaging scans, hospitalizations, specialist visits, emergency room visits, mean number of imaging scans, general physician visits, and blood transfusions all varied significantly among geographic regions.
This population-based study demonstrates an average cost per patient similar to that shown in randomized controlled trials; however, costs for either treatment approach varied by geographic region. Understanding the regional variation in costs and resource utilization is important with respect to delivering optimal treatment in a cost-effective strategy.
手术切除和辅助化疗已成为可切除早期非小细胞肺癌（NSCLC）的标准治疗方法。本研究旨在描述和比较接受辅助化疗与未接受辅助化疗的可切除NSCLC患者的整体和区域资源利用情况及成本。
利用行政数据对2004年至2006年间确诊的可切除NSCLC患者进行基于人群的回顾性队列研究（这些患者代表了直接受临床实践变化影响的队列）。患者从手术日期开始随访四年。采用医疗保健系统视角，成本估算（2012年美元）来自行政数据和文献。
纳入3354例患者。接受手术和辅助化疗的患者平均成本为37,860.88美元，显著高于仅接受手术治疗的患者平均成本32,221.45美元（p<0.0001）。在各地区中，接受手术和化疗患者的成本（32,672 - 45,453美元）与仅接受手术患者的成本（28,679 - 36,845美元）差异显著（p<0.0001）。化疗率、接受任何影像扫描的患者比例、住院率、专科就诊率、急诊就诊率、平均影像扫描次数、全科医生就诊率和输血率在不同地理区域均有显著差异。
这项基于人群的研究表明，每位患者的平均成本与随机对照试验中的结果相似；然而，两种治疗方法的成本因地理区域而异。了解成本和资源利用的区域差异对于以具有成本效益的策略提供最佳治疗非常重要。
