Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island
Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia
J Natl Compr Canc Netw. 2017 Nov;15(11):1401-1409. doi: 10.6004/jnccn.2017.0167.
Understanding the patterns of healthcare utilization and costs during the initial phase of care (12 months after breast cancer [BC] diagnosis) in older women (aged ≥65 years) is crucial in the allocation of Medicare resources. The objective of this study was to determine healthcare utilization and costs during the initial phase of care in older, female, Medicare fee-for-service beneficiaries diagnosed with BC, and to determine the factors associated with higher costs. A retrospective observational study using the SEER-Medicare linked database was conducted in 69,307 women aged ≥66 years diagnosed with primary incident BC in 2003-2009 to determine healthcare utilization, average costs, and costs for specific services during the initial phase of care. Generalized linear model regression was conducted to identify the factors associated with higher costs in a multivariate framework. A total of 96% of women were treated with surgery during the initial phase of BC care, whereas 21% and 54% underwent chemotherapy and radiotherapy, respectively. Costs during the initial phase of care totalled $28,075 in 2012 USD, comprising $13,344 for physician services and $7,456 for outpatient services. Factors associated with higher costs during the initial phase of care were younger age (66-69 years), African American race, higher household income, advanced stages of BC, initial BC treatment, higher number of primary care physician visits, and presence of comorbidities and/or a mental condition. The economic burden of BC is substantial during the initial phase of care. Physician and outpatient services accounted for the highest proportion of costs. Predisposing factors, need-related factors, healthcare use, and external environmental healthcare factors significantly predicted costs during the initial phase of care.
了解老年女性（≥65 岁）乳腺癌（BC）诊断后初始治疗阶段（诊断后 12 个月）的医疗保健利用和费用模式对于医疗保险资源的分配至关重要。本研究的目的是确定诊断为 BC 的老年女性、医疗保险按服务收费受益人的初始治疗阶段的医疗保健利用和费用，并确定与更高费用相关的因素。本研究使用 SEER-Medicare 链接数据库进行了回顾性观察研究，纳入了 2003 年至 2009 年间诊断为原发性 BC 的≥66 岁女性共 69307 例，以确定初始治疗阶段的医疗保健利用、平均费用和特定服务的费用。采用广义线性模型回归在多变量框架下确定与更高费用相关的因素。在初始 BC 治疗阶段，96%的女性接受了手术治疗，分别有 21%和 54%的女性接受了化疗和放疗。2012 年美元的初始治疗阶段费用总计 28075 美元，其中包括 13344 美元的医生服务费和 7456 美元的门诊服务费。与初始治疗阶段费用较高相关的因素包括年龄较小（66-69 岁）、非裔美国人、家庭收入较高、BC 分期较晚、初始 BC 治疗、初级保健医生就诊次数较多、合并症和/或精神疾病。BC 在初始治疗阶段的经济负担很大。医生和门诊服务占费用的最大比例。发病前因素、需求相关因素、医疗保健使用和外部环境医疗保健因素显著预测了初始治疗阶段的费用。
