Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts.
Columbia University Medical Center, New York City, New York.
Cancer Med. 2019 Sep;8(11):5158-5172. doi: 10.1002/cam4.2451. Epub 2019 Jul 26.
Detailed cost estimates are not widely available for esophageal cancer. Our study estimates phase-specific costs for esophageal cancer by age, year, histology, stage, and treatment for older patients in the United States and compares these costs within stage and treatment modalities.
We identified 8061 esophageal cancer patients in the Surveillance, Epidemiology, and End Results-Medicare database for years 1998-2013. Total, cancer-attributable, and patient-liability costs were calculated based on separate phases of care-staging (or surgery), initial, continuing, and terminal. We estimated costs by treatment modality within stage and phase for esophageal adenocarcinoma and squamous cell carcinoma separately. We fit linear regression models using log transformation to determine cost by age and calendar year. All costs are reported in 2018 US dollars.
Overall, mean (95% CI) monthly total cost estimates were high during the staging ($8953 [$8385-$9485]) and initial phases ($7731 [$7492-$7970]), decreased over the continuing phase ($2984 [$2814-$3154]), and increased substantially during the 6-month terminal phase ($18 150 [$17 211-$19 089]). This pattern of high staging and initial phase costs, decreasing continuing phase costs, and increasing terminal phase costs was seen in all stages. The highest staging costs were in stages III ($9249, $8025-$10 474) and II ($9171, $7642-$10 699). The highest initial phase cost was in stage IV, $9263 ($8758-49 768), the lowest continuing phase cost was in stage I, $2338 ($2160-$2517), and the highest terminal phase costs were in stages II ($20 533, $17 772-$23 293) and III ($20 599, $18 268-$22 929). The linear regression models showed that cancer-attributable costs remained stable over the study period and were unaffected by age for most histology, stage, and treatment modality subgroups.
Our estimates demonstrate that esophageal cancer costs can vary widely by histology, stage, and treatment. These cost estimates can be used to guide future resource allocation for esophageal cancer care and research.
食管癌的详细成本估算并不广泛。我们的研究通过年龄、年份、组织学、分期和治疗方法，为美国的老年患者估算了食管癌各阶段的特定成本，并在分期和治疗方式内比较了这些成本。
我们在美国监测、流行病学和结果-医疗保险数据库中确定了 8061 名食管癌患者，研究年限为 1998-2013 年。根据分期（或手术）、初始、持续和终末期的不同护理阶段，计算总费用、癌症相关费用和患者责任费用。我们分别对食管腺癌和鳞状细胞癌按分期和阶段内的治疗方式估算成本。我们使用对数转换的线性回归模型确定按年龄和日历年度计算的成本。所有成本均以 2018 年美元报告。
总体而言，分期阶段（8953 美元[8385-9485 美元]）和初始阶段（7731 美元[7492-7970 美元]）的月均总费用估计值较高，持续阶段（2984 美元[2814-3154 美元]）的费用逐月减少，而 6 个月终末期（18150 美元[17211-19089 美元]）的费用大幅增加。所有分期阶段都呈现出这种高分期和初始阶段费用、持续阶段费用减少、终末期费用增加的模式。III 期（9249 美元，8025-10474 美元）和 II 期（9171 美元，7642-10699 美元）的分期费用最高。IV 期的初始阶段费用最高，为 9263 美元（8758-49768 美元），I 期的持续阶段费用最低，为 2338 美元（2160-2517 美元），II 期（20533 美元，17772-23293 美元）和 III 期（20599 美元，18268-22929 美元）的终末期费用最高。线性回归模型表明，在研究期间，癌症相关成本保持稳定，并且大多数组织学、分期和治疗方式亚组的成本不受年龄影响。
我们的估计表明，食管癌的成本因组织学、分期和治疗方法而异。这些成本估计可用于指导未来食管癌护理和研究的资源分配。
