Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
Columbia University Medical Center, New York City, New York, United States of America.
PLoS One. 2020 Apr 14;15(4):e0231599. doi: 10.1371/journal.pone.0231599. eCollection 2020.
Our study analyzed disparities in utilization and phase-specific costs of care among older colorectal cancer patients in the United States. We also estimated the phase-specific costs by cancer type, stage at diagnosis, and treatment modality.
We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients aged 66 or older diagnosed with colon or rectal cancer between 2000-2013, with follow-up to death or December 31, 2014. We divided the patient's experience into separate phases of care: staging or surgery, initial, continuing, and terminal. We calculated total, cancer-attributable, and patient-liability costs. We fit logistic regression models to determine predictors of treatment receipt and fit linear regression models to determine relative costs. All costs are reported in 2019 US dollars.
Our cohort included 90,023 colon cancer patients and 25,581 rectal cancer patients. After controlling for patient and clinical characteristics, Non-Hispanic Blacks were less likely to receive treatment but were more likely to have higher cancer-attributable costs within different phases of care. Overall, in both the colon and rectal cancer cohorts, mean monthly cost estimates were highest in the terminal phase, next highest in the staging phase, decreased in the initial phase, and were lowest in the continuing phase.
Racial/ethnic disparities in treatment utilization and costs persist among colorectal cancer patients. Additionally, colorectal cancer costs are substantial and vary widely among stages and treatment modalities. This study provides information regarding cost and treatment disparities that can be used to guide clinical interventions and future resource allocation to reduce colorectal cancer burden.
本研究分析了美国老年结直肠癌患者在治疗利用和各阶段特定成本方面的差异。我们还按癌症类型、诊断时的分期和治疗方式估计了各阶段特定的成本。
我们使用监测、流行病学和最终结果（SEER）-医疗保险数据库，确定了 2000 年至 2013 年间年龄在 66 岁或以上、患有结肠癌或直肠癌的患者，并随访至死亡或 2014 年 12 月 31 日。我们将患者的治疗经历分为单独的治疗阶段：分期或手术、初始、持续和终末期。我们计算了总费用、癌症相关费用和患者自付费用。我们拟合了逻辑回归模型来确定治疗接受的预测因素，并拟合了线性回归模型来确定相对成本。所有成本均以 2019 年美元报告。
我们的队列包括 90023 例结肠癌患者和 25581 例直肠癌患者。在控制了患者和临床特征后，非西班牙裔黑人接受治疗的可能性较小，但在不同治疗阶段的癌症相关费用更高。总体而言，在结肠癌和直肠癌队列中，终端阶段的月平均成本估计最高，其次是分期阶段，初始阶段的成本降低，持续阶段的成本最低。
结直肠癌患者的治疗利用和成本方面仍然存在种族/民族差异。此外，结直肠癌的成本很高，并且在不同的分期和治疗方式之间差异很大。本研究提供了有关成本和治疗差异的信息，可用于指导临床干预和未来资源分配，以减轻结直肠癌负担。
