Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
Surgical Outcomes Research Center, University of Washington, Seattle, Washington
J Natl Compr Canc Netw. 2016 Apr;14(4):429-37. doi: 10.6004/jnccn.2016.0049.
In preparation for payment reform, we evaluated Medicare payments for the initial treatment of patients with advanced ovarian cancer and assessed factors responsible for variation.
Using the linked SEER-Medicare database, we identified a cohort of 9,491 women aged 65 years or older with stage III/IV epithelial ovarian cancer diagnosed between 1995 and 2007. Diagnostic and procedural codes specific to the care of ovarian cancer were used to estimate total medical costs for the treatment of ovarian cancer. Costs were adjusted for geography and for inflation to the 2009 US dollar. NCCN Guideline-consistent care was defined as surgery and 6 cycles of chemotherapy. A generalized linear regression was performed to assess factors associated with variability in cost.
The mean total payment per patient in the initial treatment period was $65,908 (range of means, $30,745-$96,360). Increasing medical comorbidity, use of PET/CT, surgical complications, and readmissions were associated with increased costs. Treatment with NCCN Guideline-consistent surgery and chemotherapy had a mean annual cost of $85,987 compared with $89,149 for non-NCCN Guideline-consistent treatment with surgery and chemotherapy. The cost of surgery and chemotherapy that was not consistent with NCCN Guidelines was approximately $7,000 more than the cost of therapy that was consistent (P<.001) CONCLUSIONS: The financial burden of caring for patients with ovarian cancer is substantial. Treatment that is consistent with NCCN recommendations for treating advanced ovarian cancer, which is shown to have improved outcomes, is not associated with higher cost.
为了准备支付改革，我们评估了医疗保险对晚期卵巢癌初始治疗的支付情况，并评估了导致变异的因素。
我们使用链接的 SEER-Medicare 数据库，确定了 1995 年至 2007 年间诊断为 III/IV 期上皮性卵巢癌的 9491 名 65 岁或以上女性的队列。使用特定于卵巢癌护理的诊断和程序代码来估计卵巢癌治疗的总医疗费用。根据地理位置和 2009 年美元进行了成本调整。NCCN 指南一致的护理定义为手术和 6 个周期的化疗。使用广义线性回归评估与成本变化相关的因素。
初始治疗期间每位患者的平均总付款为 65908 美元（平均值范围为 30745 美元至 96360 美元）。医疗合并症增加、使用 PET/CT、手术并发症和再入院与成本增加有关。接受 NCCN 指南一致的手术和化疗治疗的患者平均每年的费用为 85987 美元，而非 NCCN 指南一致的手术和化疗治疗的费用为 89149 美元。不符合 NCCN 指南的手术和化疗费用比符合 NCCN 指南的治疗费用高出约 7000 美元（P<.001）。
照顾卵巢癌患者的经济负担很大。与不符合 NCCN 建议的治疗晚期卵巢癌的治疗相比，符合 NCCN 建议的治疗方法可改善预后，且与更高的成本无关。
