Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
Am J Obstet Gynecol. 2019 Aug;221(2):136.e1-136.e9. doi: 10.1016/j.ajog.2019.04.005. Epub 2019 Apr 6.
Communicating healthcare costs to patients is an important component of delivering high-quality value-based care, yet cost data are lacking. This is especially relevant for ovarian cancer, where no clinical consensus on optimal first-line treatment exists.
The objective of this study was to generate cost estimates of different primary management strategies in ovarian cancer.
All women who underwent treatment for ovarian cancer from 2006-2015 were identified from the MarketScan database (n=12,761) in this observational cohort study. Total and out-of-pocket costs were calculated with the use of all claims within 8 months from initial treatment and normalized to 2017 US dollars. The generalized linear model method was used to assess cost by strategy.
Among patients who underwent neoadjuvant chemotherapy and those who underwent primary debulking, mean adjusted total costs were $113,660 and $107,153 (P<.001) and mean out-of-pocket costs were $2519 and $2977 (P<.001), respectively. Total costs for patients who had intravenous standard, intravenous dose-dense, and intraperitoneal/intravenous chemotherapy were $105,047, $115,099, and $121,761 (P<.001); and out-of-pocket costs were $2838, $3405, and $2888 (P<.001), respectively. Total costs for regimens that included bevacizumab were higher than those without it ($171,468 vs $104,482; P<.001); out-of-pocket costs were $3127 vs $2898 (P<.001). Among patients who did not receive bevacizumab, 25% paid ≥$3875, and 10% paid ≥$6265. For patients who received bevacizumab, 25% paid ≥$4480, and 10% paid ≥$6635. Among patients enrolled in high-deductible health plans, median out-of-pocket costs were $4196, with 25% paying ≥$6680 and 10% paying ≥$9751.
Costs vary across different treatment strategies, and patients bear a significant out-of-pocket burden, especially those enrolled in high-deductible health plans.
向患者传达医疗保健费用是提供高质量基于价值的护理的重要组成部分，但缺乏成本数据。对于没有临床共识的卵巢癌来说，这一点尤其重要。
本研究旨在估算卵巢癌不同初始管理策略的成本。
在这项观察性队列研究中，从 MarketScan 数据库（n=12761）中确定了 2006 年至 2015 年间接受卵巢癌治疗的所有女性。使用初始治疗后 8 个月内的所有索赔计算总费用和自付费用，并标准化为 2017 年美元。使用广义线性模型方法评估策略的成本。
接受新辅助化疗和初次减瘤术的患者，调整后的总费用分别为 113660 美元和 107153 美元（P<.001），自付费用分别为 2519 美元和 2977 美元（P<.001）。接受静脉标准、静脉剂量密集和腹腔/静脉化疗的患者总费用分别为 105047 美元、115099 美元和 121761 美元（P<.001）；自付费用分别为 2838 美元、3405 美元和 2888 美元（P<.001）。包含贝伐珠单抗的方案总费用高于不包含贝伐珠单抗的方案（171468 美元比 104482 美元；P<.001）；自付费用分别为 3127 美元和 2898 美元（P<.001）。在未接受贝伐珠单抗治疗的患者中，有 25%支付≥3875 美元，有 10%支付≥6265 美元。接受贝伐珠单抗治疗的患者中，有 25%支付≥4480 美元，有 10%支付≥6635 美元。在参加高免赔额健康计划的患者中，自付费用中位数为 4196 美元，有 25%支付≥6680 美元，有 10%支付≥9751 美元。
不同治疗策略的成本存在差异，患者自付费用负担沉重，尤其是参加高免赔额健康计划的患者。
