Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
Support Care Cancer. 2018 Apr;26(4):1221-1231. doi: 10.1007/s00520-017-3945-8. Epub 2017 Nov 3.
The aim of this study is to investigate the associations between patient activation and total costs in cancer patients treated with total laryngectomy (TL).
All members of the Dutch Patients' Association for Laryngectomees were asked to participate in this cross-sectional study. TL patients who wanted to participate were asked to complete a survey. Costs were measured using the medical consumption and productivity cost questionnaire and patient activation using the Patient Activation Measure (PAM). Sociodemographic and clinical characteristics were self-reported, and health status measured using the EQ-5D. The difference in total costs from a healthcare and societal perspective among four groups with different PAM levels were compared using (multiple) regression analyses (5000 bootstrap replications).
In total, 248 TL patients participated. Patients with a higher (better) PAM (levels 2, 3, and 4) had a probability of 70, 80, and 93% that total costs from a healthcare perspective were lower than in patients with the lowest PAM level (difference €-375 to €-936). From a societal perspective, this was 73, 87, and 82% (difference €-468 to €-719). After adjustment for time since TL, education, and sex, the probability that total costs were lower in patients with a higher PAM level compared to patients with the lowest PAM level changed to 62-91% (healthcare) and 63-92% (societal). After additional adjustment for health status, the probability to be less costly changed to 35-71% (healthcare) and 31-48% (societal).
A better patient activation is likely to be associated with lower total costs from a healthcare and societal perspective.
本研究旨在探讨喉全切除术后患者的患者激活程度与总费用之间的关系。
荷兰喉切除患者协会的所有成员都被邀请参与这项横断面研究。有意愿参与的喉全切除术后患者被要求完成一份调查问卷。使用医疗消费和生产力成本问卷以及患者激活量表（PAM）来衡量成本。社会人口统计学和临床特征由患者自行报告，健康状况则使用 EQ-5D 进行评估。使用（多次）回归分析（5000 次自举复制）比较了四个不同 PAM 水平组之间从医疗保健和社会角度来看的总费用差异。
共有 248 名喉全切除术后患者参与了本研究。PAM 水平较高（较好）的患者（第 2、3 和 4 级）从医疗保健角度来看，总费用比 PAM 水平最低的患者低的概率分别为 70%、80%和 93%（差异为-375 至-936 欧元）。从社会角度来看，这一概率分别为 73%、87%和 82%（差异为-468 至-719 欧元）。在校正喉全切除术后时间、教育程度和性别后，PAM 水平较高的患者的总费用比 PAM 水平最低的患者低的概率分别变为 62%-91%（医疗保健）和 63%-92%（社会）。在进一步调整健康状况后，费用较低的概率分别变为 35%-71%（医疗保健）和 31%-48%（社会）。
患者激活程度的提高可能与从医疗保健和社会角度来看的总费用降低有关。
