Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
BMC Cancer. 2018 Jun 27;18(1):694. doi: 10.1186/s12885-018-4620-2.
Esophageal adenocarcinoma (EAC) incidence is increasing rapidly. Esophageal cancer has the second lowest 5-year survival rate of people diagnosed with cancer in Canada. Given the poor survival and the potential for further increases in incidence, phase-specific cost estimates constitute an important input for economic evaluation of prevention, screening, and treatment interventions. The study aims to estimate phase-specific net direct medical costs of care attributable to EAC, costs stratified by cancer stage and treatment, and predictors of total net costs of care for EAC.
A population-based retrospective cohort study was conducted using Ontario Cancer Registry-linked administrative health data from 2003 to 2011. The mean net costs of EAC care per 30 patient-days (2016 CAD) were estimated from the payer perspective using phase of care approach and generalized estimating equations. Predictors of net cost by phase of care were based on a generalized estimating equations model with a logarithmic link and gamma distribution adjusting for sociodemographic and clinical factors.
The mean net costs of EAC care per 30 patient-days were $1016 (95% CI, $955-$1078) in the initial phase, $669 (95% CI, $594-$743) in the continuing care phase, and $8678 (95% CI, $8217-$9139) in the terminal phase. Overall, stage IV at diagnosis and surgery plus radiotherapy for EAC incurred the highest cost, particularly in the terminal phase. Strong predictors of higher net costs were receipt of chemotherapy plus radiotherapy, surgery plus chemotherapy, radiotherapy alone, surgery alone, and chemotherapy alone in the initial and continuing care phases, stage III-IV disease and patients diagnosed with EAC later in a calendar year (2007-2011) in the initial and terminal phases, comorbidity in the continuing care phase, and older age at diagnosis (70-74 years), and geographic region in the terminal phase.
Costs of care vary by phase of care, stage at diagnosis, and type of treatment for EAC. These cost estimates provide information to guide future resource allocation decisions, and clinical and policy interventions to reduce the burden of EAC.
食管腺癌（EAC）的发病率正在迅速上升。在加拿大，癌症患者的 5 年生存率中，食管癌的生存率排名第二低。鉴于生存率较差，以及发病率进一步上升的可能性，特定阶段的成本估算构成了预防、筛查和治疗干预措施经济评估的重要投入。本研究旨在估计 EAC 特定阶段的直接医疗护理净成本，按癌症分期和治疗分层的成本，以及 EAC 总护理净成本的预测因素。
利用 2003 年至 2011 年安大略癌症登记处链接的行政健康数据，进行了一项基于人群的回顾性队列研究。从支付者的角度，采用分阶段护理方法和广义估计方程，估算每 30 个患者日（2016 加元）的 EAC 护理净成本。根据广义估计方程模型，采用对数链接和伽马分布，调整社会人口统计学和临床因素，对各阶段护理的净成本预测因素进行了分析。
EAC 护理每 30 个患者日的净成本平均值分别为初始阶段 1016 加元（95%置信区间，955-1078），持续护理阶段 669 加元（95%置信区间，594-743），终末期 8678 加元（95%置信区间，8217-9139）。总体而言，诊断时为 IV 期和 EAC 的手术加放疗费用最高，尤其是在终末期。在初始和持续护理阶段，接受化疗加放疗、手术加化疗、单独放疗、单独手术和单独化疗是净成本较高的强预测因素；在初始和终末期，III-IV 期疾病和在日历年内（2007-2011 年）较晚诊断的 EAC 患者；在持续护理阶段，合并症；以及在终末期，年龄较大（70-74 岁）和地理位置，也是净成本较高的预测因素。
EAC 的护理成本因护理阶段、诊断时的分期和治疗类型而异。这些成本估算为指导未来资源分配决策以及减少 EAC 负担的临床和政策干预措施提供了信息。
