Merck & Co Inc, Kenilworth, NJ.
Merck & Co Inc, Kenilworth, NJ.
Clin Genitourin Cancer. 2018 Aug;16(4):e909-e917. doi: 10.1016/j.clgc.2018.03.002. Epub 2018 Mar 27.
Systemic chemotherapy has long been the standard of care for advanced bladder cancer, but its cost implications are poorly understood. The objective of this analysis was to estimate survival and health care costs for patients with stage IV bladder cancer who did or did not receive chemotherapy.
This was a retrospective cohort study of patients identified in the Surveillance, Epidemiology, and End Results-Medicare database with a new primary diagnosis of stage IV bladder cancer between January 2007 and December 2011. Survival and health care visits and costs following the date of diagnosis were determined for treated and untreated patients. Costs were expressed in 2016 US dollars.
A total of 1215 patients were diagnosed with stage IV bladder cancer, of whom 411 (33.8%) were treated with chemotherapy and 804 (66.2%) were untreated. Median overall survival was 10 months longer for treated than for untreated patients: 13.2 (95% confidence interval, 12.3-14.1) months versus 3.2 (95% confidence interval, 3.0-3.5) months. Treated patients had fewer per-patient-per-month (PPPM) health care visits than untreated patients (7.5 vs. 10.2, P < .01) and lower total PPPM health care costs ($10,707 vs. $18,935). Overall mean total lifetime costs were greater for treated than for untreated patients ($139,893 vs. $66,829, P < .05), which was driven by an approximate 4-fold increase in life expectancy for the treated patients.
Approximately two thirds of patients diagnosed with stage IV bladder cancer were not treated with systemic chemotherapy. Increasing the percentage of treated patients in this population could potentially extend overall survival while simultaneously lowering PPPM costs.
系统化疗一直是晚期膀胱癌的标准治疗方法，但对其成本的了解甚少。本分析的目的是估计未接受化疗和接受化疗的 IV 期膀胱癌患者的生存和医疗保健成本。
这是一项回顾性队列研究，纳入了 2007 年 1 月至 2011 年 12 月期间 Surveillance, Epidemiology, and End Results-Medicare 数据库中诊断为 IV 期膀胱癌的新患者。根据诊断日期确定接受和未接受治疗的患者的生存和医疗保健就诊次数和成本。成本以 2016 年美元表示。
共诊断出 1215 例 IV 期膀胱癌患者，其中 411 例（33.8%）接受了化疗，804 例（66.2%）未接受治疗。与未接受治疗的患者相比，接受治疗的患者总生存时间中位数长 10 个月：13.2 个月（95%置信区间，12.3-14.1）与 3.2 个月（95%置信区间，3.0-3.5）。接受治疗的患者每患者每月（PPPM）就诊次数少于未接受治疗的患者（7.5 次与 10.2 次，P<.01），总 PPPM 医疗保健费用也较低（10707 美元与 18935 美元）。与未接受治疗的患者相比，接受治疗的患者的总终生平均费用更高（139893 美元与 66829 美元，P<.05），这是由于接受治疗的患者的预期寿命增加了约 4 倍。
约三分之二的 IV 期膀胱癌患者未接受系统化疗。增加该人群中接受治疗的患者的比例可能会延长总体生存时间，同时降低 PPPM 成本。
