欧洲晚期非小细胞肺癌的费用负担及其与疾病分期的关系。
Cost burden associated with advanced non-small cell lung cancer in Europe and influence of disease stage.
机构信息
Adelphi Real World, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK.
出版信息
BMC Cancer. 2019 Mar 8;19(1):214. doi: 10.1186/s12885-019-5428-4.
BACKGROUND
Although evidence suggests that stage of disease may influence costs associated with non-small cell lung cancer (NSCLC), there remains a relative paucity of data on the financial burden incurred directly by patients and their informal caregivers as they progress through the disease course. As part of a large, cross-sectional study of the "real-world" humanistic and financial burden of advanced NSCLC in Europe, an analysis was conducted to quantify the cost burden of disease from a patient and caregiver perspective, and to evaluate how stage of disease impacts these costs.
METHODS
Financial data were collected (May 2015-June 2016) during a multinational (France, Germany, and Italy) cross-sectional study of adults with advanced NSCLC (stage IIIB-IV) and their informal (unpaid) caregivers. Data were obtained via medical chart reviews and patient/caregiver self-completion forms. Costs were annualized and unadjusted or adjusted for government financial support. Statistical significance was assessed using Mann-Whitney U tests.
RESULTS
One thousand thirty patients and 427 accompanying caregivers were recruited and asked to provide cost data. Mean total unadjusted direct and indirect out-of-pocket expenses were €5691 for patients and €4125 for caregivers; after adjusting for government financial support, values were €2644 and €3477. Mean wage losses were significantly higher for patients with stage IV vs IIIB NSCLC (€2282 vs €499; p = 0.0135) as were unadjusted direct out-of-pocket expenses (€4020 vs €1546; p = 0.0306). For caregivers, a similar but non-significant trend was observed. Mean total unadjusted direct and indirect out-of-pocket costs were numerically higher for stage IV vs IIIB NSCLC among patients (€5925 vs €3528) and caregivers (€4319 vs €2232); government financial support normalized patient costs, but they remained numerically higher for stage IV disease among caregivers.
CONCLUSIONS
The financial burden of advanced NSCLC is considerable and appears to be influenced by stage of disease, with direct and indirect costs increasing as the disease progresses. Government financial support programmes appear to mitigate additional cost burdens among patients, but not among caregivers.
背景
尽管有证据表明疾病分期可能会影响非小细胞肺癌（NSCLC）相关的成本，但关于患者及其非专业照护者在疾病进展过程中直接承担的经济负担的数据仍然相对较少。作为一项关于欧洲晚期 NSCLC 真实世界人文和经济负担的大型横断面研究的一部分，对患者和照护者视角下的疾病成本负担进行了分析，并评估了疾病分期如何影响这些成本。
方法
在一项关于晚期 NSCLC（IIIb-IV 期）患者及其非专业（无报酬）照护者的多国（法国、德国和意大利）横断面研究中，于 2015 年 5 月至 2016 年 6 月期间收集了财务数据。数据通过病历回顾和患者/照护者自我报告表获取。成本进行了年化处理，且未调整或根据政府财政支持进行了调整。采用 Mann-Whitney U 检验评估统计学意义。
结果
共招募了 1030 名患者和 427 名陪同照护者，并要求他们提供成本数据。未调整的直接和间接总自付费用患者为 5691 欧元，照护者为 4125 欧元；调整政府财政支持后，患者为 2644 欧元，照护者为 3477 欧元。IV 期 NSCLC 患者的工资损失明显高于 IIIb 期 NSCLC 患者（2282 欧元比 499 欧元；p=0.0135），未调整的直接自付费用也更高（4020 欧元比 1546 欧元；p=0.0306）。照护者也观察到类似但不显著的趋势。未调整的直接和间接总自付费用患者中 IV 期 NSCLC 高于 IIIb 期 NSCLC（5925 欧元比 3528 欧元），照护者中 IV 期 NSCLC 高于 IIIb 期 NSCLC（4319 欧元比 2232 欧元）；政府财政支持使患者的成本标准化，但照护者中 IV 期疾病的成本仍高于 IIIb 期。
结论
晚期 NSCLC 的经济负担相当大，且似乎受到疾病分期的影响，随着疾病的进展，直接和间接成本增加。政府财政支持计划似乎减轻了患者的额外经济负担，但对照护者没有影响。
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