Davies L M, Hayhurst K P, Lorigan P, Molassiotis A
Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK.
Division of Psychology and Mental Health, The University of Manchester, Manchester, UK.
Eur J Cancer Care (Engl). 2018 Mar;27(2):e12811. doi: 10.1111/ecc.12811. Epub 2018 Jan 9.
We explored the relationship between unmet care needs, health status, health utility and costs in people treated for melanoma via a cross-sectional follow-up survey (N = 455) 3 months to 5 years after complete resection of stage I-III cutaneous malignant melanoma. 51% (n = 232) had unmet care needs. This group had higher mean resource use, estimated conservatively (£28 vs. £10 per person) and worse overall health. Mean health-related utility index (AQoL6D) was 0.763 (95% CI 0.74; 0.79) in those with self-reported unmet need vs. 0.903 (0.89; 0.92) in those with no unmet need. Melanoma survivors with unmet need had worse outcomes in terms of anxiety (HADS 6.86 vs. 4.29), depression (HADS 4.29 vs. 2.01), overall quality of life (QoL: FACT-M 84.2 vs. 96.5). Higher resource use was associated with younger age (r = -.29, p < .001), older school-leaving age (r = .21, p < .001), reduced health utility (r = -.14, p = .005), higher anxiety (r = .22, p < .001), higher depression (r = .16, p = .001) and lower QoL (overall r = -.24, p < .001; melanoma QoL r = -.20, p < .001; surgery QoL r = -.19, p < .001). Lower health outcomes indicate increased service use, suggesting that interventions to address unmet need and improve health outcomes may reduce health costs. Integrated clinical and economic evaluations of interventions that target unmet need in melanoma survivors are required.
我们通过一项横断面随访调查（N = 455），对I - III期皮肤恶性黑色素瘤完全切除术后3个月至5年的患者，探讨了未满足的护理需求、健康状况、健康效用和成本之间的关系。51%（n = 232）的患者有未满足的护理需求。该组患者的平均资源使用量更高（保守估计为每人28英镑对10英镑），总体健康状况更差。自我报告有未满足需求的患者的平均健康相关效用指数（AQoL6D）为0.763（95%置信区间0.74；0.79），而无未满足需求的患者为0.903（0.89；0.92）。有未满足需求的黑色素瘤幸存者在焦虑（医院焦虑抑郁量表评分6.86对4.29）、抑郁（医院焦虑抑郁量表评分4.29对2.01）、总体生活质量（生活质量：FACT - M量表评分84.2对96.5）方面的结果更差。更高的资源使用与更年轻的年龄（r = -0.29，p < 0.001）、更高的离校年龄（r = 0.21，p < 0.001）、更低的健康效用（r = -0.14，p = 0.005）、更高的焦虑（r = 0.22，p < 0.001）、更高的抑郁（r = 0.16，p = 0.001）以及更低的生活质量（总体r = -0.24，p < 0.001；黑色素瘤生活质量r = -0.20，p < 0.001；手术生活质量r = -0.19，p < 0.001）相关。更低的健康结果表明服务使用增加，这表明针对未满足需求并改善健康结果的干预措施可能会降低医疗成本。需要对针对黑色素瘤幸存者未满足需求的干预措施进行综合临床和经济评估。
