Eaglehouse Yvonne L, Manjelievskaia Janna, Shao Stephanie, Brown Derek, Hofmann Keith, Richard Patrick, Shriver Craig D, Zhu Kangmin
John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD.
Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD.
Mil Med. 2018 Nov 1;183(11-12):e500-e508. doi: 10.1093/milmed/usy052.
Breast cancer care imposes a significant financial burden to U.S. healthcare systems. Health services factors, such as insurance benefit type and care source, may impact costs to the health system. Beneficiaries in the U.S. Military Health System (MHS) have universal healthcare coverage and access to a network of military facilities (direct care) and private practices (purchased care). This study aims to quantify and compare breast cancer care costs to the MHS by insurance benefit type and care source.
We conducted a retrospective analysis of data linked between the MHS data repository administrative claims and central cancer registry databases. The institutional review boards of the Walter Reed National Military Medical Center, the Defense Health Agency, and the National Institutes of Health Office of Human Subjects Research reviewed and approved the data linkage. We used the linked data to identify records for women aged 40-64 yr who were diagnosed with breast cancer between 2003 and 2007 and to extract information on insurance benefit type, care source, and cost to the MHS for breast cancer treatment. We estimated per capita costs for breast cancer care by benefit type and care source in 2008 USD using generalized linear models, adjusted for demographic, pathologic, and treatment characteristics.
The average per capita (n = 2,666) total cost for breast cancer care was $66,300 [standard error (SE) $9,200] over 3.31 (1.48) years of follow-up. Total costs were similar between benefit types, but varied by care source. The average per capita cost was $34,500 ($3,000) for direct care (n = 924), $96,800 ($4,800) for purchased care (n = 622), and $60,700 ($3,900) for both care sources (n = 1,120), respectively. Care source differences remained by tumor stage and for chemotherapy, radiation, and hormone therapy treatment types.
Per capita costs to the MHS for breast cancer care were similar by benefit type and lower for direct care compared with purchased care. Further research is needed in breast and other tumor sites to determine patterns and determinants of cancer care costs between benefit types and care sources within the MHS.
乳腺癌治疗给美国医疗系统带来了巨大的经济负担。健康服务因素，如保险福利类型和医疗服务来源，可能会影响医疗系统的成本。美国军事医疗系统（MHS）的受益人享有全民医疗保险，可使用军事设施网络（直接医疗）和私人诊所（购买性医疗）。本研究旨在按保险福利类型和医疗服务来源对MHS的乳腺癌治疗成本进行量化和比较。
我们对MHS数据存储库管理索赔数据与中央癌症登记数据库之间的关联数据进行了回顾性分析。沃尔特里德国家军事医疗中心、国防卫生局和美国国立卫生研究院人体研究办公室的机构审查委员会对数据关联进行了审查和批准。我们使用关联数据识别2003年至2007年间被诊断为乳腺癌的40 - 64岁女性的记录，并提取有关保险福利类型、医疗服务来源以及MHS乳腺癌治疗成本的信息。我们使用广义线性模型，根据人口统计学、病理学和治疗特征进行调整，估算了2008年美元计价的按福利类型和医疗服务来源划分的乳腺癌治疗人均成本。
在3.31（1.48）年的随访期内，乳腺癌治疗的人均总成本（n = 2666）为66300美元[标准误差（SE）9200美元]。不同福利类型的总成本相似，但因医疗服务来源而异。直接医疗（n = 924）的人均成本为3450（300）美元，购买性医疗（n = 622）的人均成本为9680（4800）美元，两种医疗服务来源（n = 1120）的人均成本为6070（3900）美元。不同肿瘤分期以及化疗、放疗和激素治疗类型的医疗服务来源差异依然存在。
MHS的乳腺癌治疗人均成本按福利类型相似，且直接医疗成本低于购买性医疗。需要对乳腺癌和其他肿瘤部位进行进一步研究，以确定MHS内不同福利类型和医疗服务来源之间癌症治疗成本的模式和决定因素。
