Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University, School of Pharmacy, Richmond, VA.
Department of Statistical Sciences and Operations Research, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA.
Urol Oncol. 2019 Jun;37(6):356.e19-356.e28. doi: 10.1016/j.urolonc.2019.01.016. Epub 2019 Mar 4.
This study examined the economic burden of renal cell carcinoma (RCC) among older adults. The study also examined healthcare costs by types of resources used and stage at which RCC was diagnosed.
The study analyzed the Surveillance Epidemiology and End Result-Medicare linked data. We included a prevalent cohort of RCC patients from 2013, diagnosed and continuously enrolled in Medicare from 2005 to 2013. RCC patients were matched to controls selected from a 5% sample of noncancer beneficiaries using propensity score matching to calculate incremental costs. Total healthcare costs (THC) were calculated using a phase-based approach, which classified patients into early, continuing, and late phases of care. Costs were also examined by types of resources used and stage at which RCC was diagnosed. Generalized linear models estimated annual incremental costs per patient. The number of older RCC patients was calculated using SEER-Stat and ProjPrev software. The average incremental THC was multiplied by the estimated number of RCC patients to calculate the total economic burden of RCC among older adults.
The study included 10,392 each of RCC and control patients. The average annual THC associated with RCC was $7,419 for all phases, $22,752 for the initial phase, $4,860 for the continuing phase, and $13,232 for the late phase of care. The average THC was $4,584 for patients diagnosed at stage I, $4,727 for stage II, $9,331 for stage III, and $31,637 for stage IV. For patients diagnosed at stages I to III, hospital cost (approximately $1,500-$3,400) was the largest component of THC. For stage IV patients, prescription drug cost ($11,747) was the largest component of THC. The projected number of older RCC patients in 2015 was 204,256. The annual economic burden of RCC after weighting for proportion of patients diagnosed at various stages was estimated to be $2.1 billion.
RCC was associated with a significant economic burden on Medicare. Healthcare costs associated with RCC varied substantially between early stage and metastatic patients. This research provided a baseline that can be used to assess the economic value of emerging therapies among older RCC patients.
本研究旨在探讨老年人群肾癌（RCC）的经济负担。本研究还通过使用的资源类型和 RCC 诊断阶段来检查医疗保健费用。
本研究分析了监测、流行病学和最终结果-医疗保险关联数据。我们纳入了一个来自 2013 年的 RCC 患者的流行队列，这些患者在 2005 年至 2013 年期间被诊断并持续参加医疗保险。使用倾向评分匹配，从非癌症受益人的 5%样本中选择对照患者，以计算增量成本。使用基于阶段的方法计算总医疗保健成本（THC），该方法将患者分为早期、持续和晚期护理阶段。还通过使用的资源类型和 RCC 诊断阶段来检查成本。使用广义线性模型估计每位患者的年度增量成本。使用 SEER-Stat 和 ProjPrev 软件计算老年 RCC 患者的数量。将估计的 RCC 患者数量乘以平均增量 THC，以计算老年人群中 RCC 的总经济负担。
本研究纳入了 10392 名 RCC 和对照患者。所有阶段 RCC 相关的平均年度 THC 为 7419 美元，初始阶段为 22752 美元，持续阶段为 4860 美元，晚期阶段为 13232 美元。I 期诊断的患者的平均 THC 为 4584 美元，II 期为 4727 美元，III 期为 9331 美元，IV 期为 31637 美元。对于在 I 期至 III 期诊断的患者，住院费用（约 1500-3400 美元）是 THC 的最大组成部分。对于 IV 期患者，处方药物费用（11747 美元）是 THC 的最大组成部分。2015 年老年 RCC 患者的预计数量为 204256 人。加权后按各阶段诊断患者比例计算，RCC 的年经济负担估计为 21 亿美元。
RCC 给医疗保险带来了重大的经济负担。RCC 相关的医疗保健费用在早期阶段和转移性患者之间差异很大。这项研究提供了一个基线，可以用来评估老年 RCC 患者新兴疗法的经济价值。
