Division of Hematology and Oncology.
School of Nursing.
J Natl Compr Canc Netw. 2019 Oct 1;17(10):1221-1228. doi: 10.6004/jnccn.2019.7316.
Treatment for metastatic breast cancer (MBC) that is not concordant with the NCCN Guidelines for Breast Cancer has been associated with higher healthcare utilization and payer costs. However, a significant knowledge gap exists regarding the impact of guideline-discordant care on patient cost responsibility. This study examined this question among patients with MBC in the year postdiagnosis.
This retrospective cohort study used data from the SEER-Medicare linked database from 2000 through 2013. Guideline discordance, defined by year-specific NCCN Guidelines, was assessed for first-line antineoplastic treatment and grouped into discrete categories. Patient cost responsibility (deductibles, coinsurance, copayments) in women with MBC were summed for all medical care received in the year postdiagnosis. The difference in patient cost responsibility by guideline discordance status was estimated using linear mixed-effect models.
Of 3,709 patients with MBC surviving at least 1 year postdiagnosis, 17.6% (n=651) received guideline-discordant treatment. Median cost responsibility in the year postdiagnosis for patients receiving guideline-discordant treatment was $7,421 (interquartile range [IQR], $4,359-$12,983) versus $5,171 (IQR, $3,006-$8,483) for those receiving guideline-concordant care. In adjusted models, guideline-discordant treatment was significantly associated with $1,841 higher patient costs in the first year from index diagnosis date (95% CI, $1,280-$2,401) compared with guideline-concordant care. Patient cost responsibility differed by category of guideline discordance, with those receiving nonapproved bevacizumab having the highest cost responsibility (β=$3,330; 95% CI, $1,711-$4,948).
Deviations from current treatment guidelines may have implications on patient healthcare cost responsibility. Additional research is needed to fully understand the mechanisms underlying how guideline deviation leads to greater costs for patients with MBC.
与 NCCN 乳腺癌指南不一致的转移性乳腺癌 (MBC) 治疗与更高的医疗保健利用率和支付方成本相关。然而，对于不符合指南的护理对患者费用责任的影响，仍存在显著的知识差距。本研究在 MBC 诊断后一年内检查了这一问题。
本回顾性队列研究使用了 2000 年至 2013 年 SEER-Medicare 链接数据库的数据。根据年度 NCCN 指南，将一线抗肿瘤治疗的不一致性定义为离散类别进行评估。在 MBC 女性中，在诊断后 1 年内所有医疗保健费用中汇总患者费用责任（自付额、共付额、共同支付额）。使用线性混合效应模型估计不符合指南的状态下患者费用责任的差异。
在至少存活 1 年的 3709 例 MBC 患者中，17.6%（n=651）接受了不符合指南的治疗。接受不符合指南治疗的患者在诊断后 1 年内的中位费用责任为 7421 美元（IQR，4359-12983 美元），而接受符合指南治疗的患者为 5171 美元（IQR，3006-8483 美元）。在调整模型中，与符合指南的治疗相比，不符合指南的治疗与第一年从指数诊断日期起患者成本高出 1841 美元显著相关（95%CI，1280-2401 美元）。患者费用责任因不符合指南的类别而异，接受未经批准的贝伐珠单抗治疗的患者费用责任最高（β=3330 美元；95%CI，1711-4948 美元）。
不符合当前治疗指南可能对患者的医疗保健费用责任产生影响。需要进一步研究以充分了解不符合指南的护理导致 MBC 患者费用增加的机制。
