Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX.
J Low Genit Tract Dis. 2019 Apr;23(2):102-109. doi: 10.1097/LGT.0000000000000472.
To determine from the perspective of the State of Texas, the direct medical care costs associated with cervical, vaginal, and vulvar cancers in Texas Medicaid enrollees.
We conducted a case-control study and searched Texas Medicaid databases between 2008 and 2012 for eligible cancer patients. A comparison group was selected for each cancer site using a 2-step 1:1 propensity score matching method. Patients were followed for 2 years after cancer diagnosis to estimate monthly and yearly direct medical costs. For each cancer site, the differential cost between patients and the matched comparison individuals was the estimated cost associated with cancer.
The study included 583 cervical, 62 vaginal, and 137 vulvar cancer patients and equal numbers of cancer-free comparison individuals. Among the cases, 322 cervical cancer patients, 46 vaginal cancer patients, and 102 vulvar cancer patients were Medicaid-Medicare dual eligible enrollees. For Medicaid-only enrollees, the adjusted first- and second-year mean total differential costs were US $19,859 and $3,110 for cervical cancer, US $19,627 and $4,582 for vaginal cancer, and US $7,631 and $777 for vulvar cancer patients, respectively. For Medicaid-Medicare dual eligible enrollees, adjusted first- and second-year mean total differential costs incurred by Medicaid were US $2,565 and $792 for cervical cancer, US $1,293 and $181 for vaginal cancer, and US $1,774 and $1,049 for vulvar cancer patients, respectively.
The direct medical costs associated with cervical, vaginal, and vulvar cancers in Texas Medicaid were substantial in the first 2 years after cancer diagnosis, but dual eligibility for Medicare coverage attenuated Medicaid costs.
从德克萨斯州的角度出发，确定在德克萨斯州医疗补助计划参保者中，与宫颈、阴道和外阴癌症相关的直接医疗费用。
我们进行了一项病例对照研究，并在 2008 年至 2012 年期间在德克萨斯州医疗补助数据库中搜索符合条件的癌症患者。使用两步 1:1 倾向评分匹配方法为每个癌症部位选择了一个对照组。在癌症诊断后，对患者进行了 2 年的随访，以估计每月和每年的直接医疗费用。对于每个癌症部位，患者与匹配的对照个体之间的差异成本即为与癌症相关的估计成本。
该研究纳入了 583 例宫颈癌、62 例阴道癌和 137 例外阴癌患者，以及同等数量的无癌症对照个体。在病例组中，有 322 例宫颈癌患者、46 例阴道癌患者和 102 例外阴癌患者是医疗补助-医疗保险双重合格参保者。对于仅参加医疗补助计划的参保者，调整后的第一年和第二年的平均总差异成本分别为 19859 美元和 3110 美元用于治疗宫颈癌症，19627 美元和 4582 美元用于治疗阴道癌症，以及 7631 美元和 777 美元用于治疗外阴癌患者。对于医疗补助-医疗保险双重合格参保者，调整后的第一年和第二年 Medicaid 发生的平均总差异成本分别为 2565 美元和 792 美元用于治疗宫颈癌症，1293 美元和 181 美元用于治疗阴道癌症，以及 1774 美元和 1049 美元用于治疗外阴癌患者。
在癌症诊断后的头 2 年，德克萨斯州医疗补助计划中与宫颈、阴道和外阴癌症相关的直接医疗费用是巨大的，但医疗保险的双重资格降低了医疗补助的成本。
