Center for Pain and Supportive Care, Phoenix, Arizona.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA Netw Open. 2019 Apr 5;2(4):e191549. doi: 10.1001/jamanetworkopen.2019.1549.
Targeted drug delivery (TDD) has potential for cost savings compared with conventional medical management (CMM). Despite positive clinical and economic evidence, TDD remains underused to treat cancer pain.
To assess the cost of TDD and CMM in treating cancer-related pain.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective economic evaluation using propensity score-matched analysis was conducted using MarketScan commercial claims data on beneficiaries receiving TDD and CMM or CMM only for cancer pain from January 1, 2009, to September 30, 2015. Participants were matched on age, sex, cancer type, comorbidity score, and pre-enrollment characteristics. Data analysis was performed from June 1 to September 30, 2017.
Total 2-, 6-, and 12-month costs, number of health care encounters, length of hospital stay, additional components of cost, and health care utilization.
A total of 376 TDD and CMM patients (mean [SD] age, 51.88 [9.98] years; 216 [57.5%] female) and 4839 CMM only patients (mean [SD] age, 51.52 [11.16] years; 3005 [62.1%] female) were identified for study inclusion. After matching, 536 patients were included in the study: 268 patients in the TDD and CMM group and 268 in the CMM only group. Compared with CMM only, TDD and CMM was associated with mean total cost savings of $15 142 (95% CI, $3690 to $26 594; P = .01) at 2 months and $63 498 (95% CI, $4620 to $122 376; P = .03) at 12 months; cost savings at 6 months were not statistically different ($19 577; 95% CI, -$12 831 to $51 984; P = .24). The TDD and CMM group had fewer inpatient visits (2-month mean difference [MD], 1.0; 95% CI, 0.8-1.2; P < .001; 6-month MD, 1.3; 95% CI, 0.8-1.7; P < .001; 12-month MD, 2.3; 95% CI, 1.2-3.4; P < .001) and shorter hospital stays (2-month MD, 6.8 days; 95% CI, 5.0-8.7 days; P < .001; 6-month MD, 6.8 days; 95% CI, 3.1-10.5 days; P < .001; 12-month MD, 10.6 days; 95% CI, 2.9-18.3 days; P = .007). Use of CMM only was associated with greater opioid use at 12 months (MD, 3.2; 95% CI, 0.4-6.0; P = .03).
Compared with CMM alone, TDD and CMM together were associated with significantly lower cost and health care utilization. The findings suggest that TDD is a cost-saving therapy that should be considered in patients with cancer for whom oral opioids are inadequate or produce intolerable adverse effects and should be expanded as health care systems transition to value-based models.
与传统医疗管理（CMM）相比，靶向药物输送（TDD）具有降低成本的潜力。尽管有积极的临床和经济证据，但 TDD 在治疗癌症疼痛方面的应用仍然不足。
评估 TDD 和 CMM 在治疗癌症相关疼痛方面的成本。
设计、地点和参与者：这项回顾性经济评估使用倾向评分匹配分析，使用 MarketScan 商业索赔数据，对 2009 年 1 月 1 日至 2015 年 9 月 30 日期间接受 TDD 和 CMM 或仅 CMM 治疗癌症疼痛的患者进行分析。参与者根据年龄、性别、癌症类型、合并症评分和入组前特征进行匹配。数据分析于 2017 年 6 月 1 日至 9 月 30 日进行。
2、6 和 12 个月的总费用、医疗保健就诊次数、住院时间、额外成本组成部分和医疗保健利用情况。
共纳入 376 例 TDD 和 CMM 患者（平均[标准差]年龄，51.88[9.98]岁；216[57.5%]为女性）和 4839 例仅 CMM 患者（平均[标准差]年龄，51.52[11.16]岁；3005[62.1%]为女性）。纳入研究后，匹配了 536 例患者：TDD 和 CMM 组 268 例，仅 CMM 组 268 例。与仅 CMM 相比，TDD 和 CMM 在 2 个月时的总成本节省了 15142 美元（95%CI，3690 美元至 26594 美元；P =.01），在 12 个月时节省了 63498 美元（95%CI，4620 美元至 122376 美元；P =.03）；6 个月时的成本节省没有统计学差异（19577 美元；95%CI，-12831 美元至 51984 美元；P =.24）。TDD 和 CMM 组的住院次数更少（2 个月的平均差值[MD]，1.0；95%CI，0.8-1.2；P<.001；6 个月 MD，1.3；95%CI，0.8-1.7；P<.001；12 个月 MD，2.3；95%CI，1.2-3.4；P<.001），住院时间更短（2 个月 MD，6.8 天；95%CI，5.0-8.7 天；P<.001；6 个月 MD，6.8 天；95%CI，3.1-10.5 天；P<.001；12 个月 MD，10.6 天；95%CI，2.9-18.3 天；P =.007）。仅使用 CMM 与 12 个月时阿片类药物用量增加有关（MD，3.2；95%CI，0.4-6.0；P =.03）。
与单独使用 CMM 相比，TDD 和 CMM 联合使用可显著降低成本和医疗保健利用率。研究结果表明，TDD 是一种具有成本效益的治疗方法，应考虑在口服阿片类药物不足或产生无法耐受的不良反应的癌症患者中使用，并应随着医疗保健系统向基于价值的模式转变而扩大应用。
