Feinstein Aaron J, Long Jessica, Soulos Pamela R, Ma Xiaomei, Herrin Jeph, Frick Kevin D, Chagpar Anees B, Krumholz Harlan M, Yu James B, Ross Joseph S, Gross Cary P
Aaron J. Feinstein is a resident in head and neck surgery at the University of California, Los Angeles, and a researcher at the Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, in New Haven, Connecticut.
Jessica Long is a researcher at the COPPER Center.
Health Aff (Millwood). 2015 Apr;34(4):592-600. doi: 10.1377/hlthaff.2014.1119.
Significant national attention has been paid to the rising costs of cancer care. However, few studies have evaluated the association between trends in costs and survival outcomes. We used the Surveillance, Epidemiology, and End Results (SEER) Program-Medicare linked database to compare changes in costs and survival rates over time, among women ages 67-94 who were diagnosed with stage II or III breast cancer in 1994-96 or 2004-06. We found that median cancer-related costs increased from $12,335 to $17,396 among women with stage II disease, and from $18,107 to $32,598 among women with stage III disease. Although the median cost of breast surgery declined between the two study periods, the median cost of chemo- and radiation therapy increased substantially, leading to an overall rise in cancer-related costs. Meanwhile, adjusted overall five-year survival improved, from 67.8 percent to 72.5 percent for women with stage II disease and from 38.5 percent to 51.9 percent for those with stage III disease. These findings suggest that increases in cancer care costs have been accompanied by improved outcomes. Future work should identify opportunities to optimize efficiency in cancer care.
癌症治疗费用的不断上涨已引起国家的高度关注。然而，很少有研究评估费用趋势与生存结果之间的关联。我们使用监测、流行病学和最终结果（SEER）计划与医疗保险的链接数据库，比较了1994 - 1996年或2004 - 2006年被诊断为II期或III期乳腺癌的67 - 94岁女性随时间推移的费用变化和生存率。我们发现，II期疾病女性的癌症相关费用中位数从12,335美元增加到17,396美元，III期疾病女性的这一数字从18,107美元增加到32,598美元。尽管两个研究期间乳房手术的费用中位数有所下降，但化疗和放疗的费用中位数大幅增加，导致癌症相关费用总体上升。与此同时，调整后的总体五年生存率有所提高，II期疾病女性从67.8%提高到72.5%，III期疾病女性从38.5%提高到51.9%。这些发现表明，癌症治疗费用的增加伴随着治疗效果的改善。未来的工作应确定优化癌症治疗效率的机会。
