Bercow Alexandra S, Chen Ling, Chatterjee Sudeshna, Tergas Ana I, Hou June Y, Burke William M, Ananth Cande V, Neugut Alfred I, Hershman Dawn L, Wright Jason D
Departments of Obstetrics and Gynecology and Medicine and the Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, the Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, and New York Presbyterian Hospital, New York, New York.
Obstet Gynecol. 2017 Dec;130(6):1269-1275. doi: 10.1097/AOG.0000000000002317.
To examine the cost of care during the first year after a diagnosis of ovarian cancer, estimate the sources of cost, and explore the out-of-pocket costs.
We performed a retrospective cohort study of women with ovarian cancer diagnosed from 2009 to 2012 who underwent both surgery and adjuvant chemotherapy using the Truven Health MarketScan database. This database is comprised of patients covered by commercial insurance sponsored by more than 100 employers in the United States. Medical expenditures, including physician reimbursement, for a 12-month period beginning on the date of surgery were estimated. All payments were examined, including out-of-pocket costs for patients. Payments were divided into expenditures for inpatient care, outpatient care (including chemotherapy), and outpatient drug costs. The 12-month treatment period was divided into three phases: surgery to 30 days (operative period), 1-6 months (adjuvant therapy), and 6-12 months after surgery. The primary outcome was the overall cost of care within the first year of diagnosis of ovarian cancer; secondary outcomes included assessment of factors associated with cost.
A total of 26,548 women with ovarian cancer who underwent surgery were identified. After exclusion of patients with incomplete insurance enrollment or coverage, those who did not undergo chemotherapy, and those with capitated plans, our cohort consisted of 5,031 women. The median total medical expenditures per patient during the first year after the index procedure were $93,632 (interquartile range $62,319-140,140). Inpatient services accounted for $30,708 (interquartile range $20,102-51,107; 37.8%) in expenditures, outpatient services $52,700 (interquartile range $31,210-83,206; 58.3%), and outpatient drug costs $1,814 (interquartile range $603-4,402; 3.8%). The median out-of-pocket expense was $2,988 (interquartile range $1,649-5,088). This included $1,509 (interquartile range $705-2,878) for outpatient services, $589 (interquartile range $3-1,715) for inpatient services, and $351 (interquartile range $149-656) for outpatient drug costs.
The average cost of care for women with ovarian cancer in the first year after surgery is approximately $100,000. Patients bear approximately 3% of these costs in the form of out-of-pocket expenses.
研究卵巢癌确诊后第一年的护理成本，估算成本来源，并探究自付费用。
我们使用Truven Health MarketScan数据库对2009年至2012年确诊为卵巢癌且接受了手术和辅助化疗的女性进行了一项回顾性队列研究。该数据库包含由美国100多家雇主赞助的商业保险覆盖的患者。估算了从手术日期开始的12个月期间的医疗支出，包括医生报销费用。检查了所有付款，包括患者的自付费用。付款分为住院护理、门诊护理（包括化疗）和门诊药品费用。12个月的治疗期分为三个阶段：手术至30天（手术期）、1至6个月（辅助治疗期）以及手术后6至12个月。主要结局是卵巢癌确诊后第一年内的总体护理成本；次要结局包括对与成本相关因素的评估。
共识别出26548例接受手术的卵巢癌女性。在排除保险登记或覆盖不完整的患者、未接受化疗的患者以及按人头付费计划的患者后，我们的队列由5031名女性组成。索引手术（即首次手术）后第一年每位患者的医疗支出中位数为93632美元（四分位间距62319 - 140140美元）。住院服务支出为30708美元（四分位间距20102 - 51107美元；占37.8%），门诊服务支出为52700美元（四分位间距31210 - 83206美元；占58.3%），门诊药品费用为1814美元（四分位间距603 - 4402美元；占3.8%）。自付费用中位数为2988美元（四分位间距1649 - 5088美元）。这包括门诊服务1509美元（四分位间距705 - 2878美元）、住院服务589美元（四分位间距3 - 1715美元）以及门诊药品费用351美元（四分位间距149 - 656美元）。
卵巢癌女性患者术后第一年的平均护理成本约为10万美元。患者以自付费用的形式承担这些成本的约3%。
