Columbia University Medical Center and the Herbert Irving Comprehensive Cancer Center, 161 Fort Washington Avenue, 10-1068, New York, NY, 10032, USA.
SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Breast Cancer Res Treat. 2020 Jun;181(2):455-463. doi: 10.1007/s10549-020-05634-1. Epub 2020 Apr 18.
Patients with cancer are at risk for unplanned hospitalizations during treatment which can increase the cost of care.
To determine demographic and clinical factors associated with healthcare utilization and costs among clinical trial participants.
DESIGN, SETTING, AND PATIENTS: We conducted a retrospective analysis among breast cancer patients over the age of 65 treated on SWOG clinical trials from 1999 to 2011 with trial data linked to Medicare claims.
The outcomes were healthcare utilization (emergency room visits (ER), hospitalizations) and costs from Medicare Claims. Demographic, clinical, and prognostic factors were captured from clinical trial records. We identified cardiovascular comorbidities/risk factors (CVD-RFs) of diabetes, hypertension, hypercholesterolemia, and coronary artery disease (CAD) from Medicare claims. Multivariable logistic and linear regression were used to assess the association between CVD-RFs and outcomes.
Among the 708 patients included in the analysis, 160 (22.6%) experienced 234 separate hospitalizations, and 193 (27.3%) experienced 311 separate ER visits. Black race was associated with an increase in hospitalizations (OR [95% CI], 2.52 [1.10-5.79], p = 0.03), but not emergency room visits compared to white race. Diabetes, hypertension, hypercholesterolemia, and CAD were all independently associated with increased risk of both hospitalizations and ER visit. Hypertension had the strongest association, with more than a threefold risk of hospitalization for those with hypertension compared to those without (OR [95% CI], 3.16 [1.85-5.40], p < 0.001). For those with ≥ 3 RFs, the risk of hospitalization was nearly 3 times greater compared to 0 or 1 CVD-RFs (OR [95% CI], 2.74 [1.71-4.38], p < 0.001). Similar results were seen for ER visits. In the first 12 months after trial registration, patients with diabetes ($38,324 vs $30,923, 23.9% increase, p = 0.05), hypercholesterolemia ($34,168 vs $30,661, 11.4% increase, p = 0.02), and CAD ($37,781 vs $31,698, 19.2% increase, p = 0.04) had statistically significantly higher total healthcare costs. Additionally, those with ≥ 2 significant CVD-RFs ($35,353 vs. $28,899, 22.3% increase, p = 0.005) had statistically significantly higher total healthcare costs.
Among participants treated on clinical trials, black race and presence of multiple cardiovascular comorbidities was associated with a substantial increase in ER visits, hospitalizations and healthcare costs. Efforts to reduce unplanned hospitalizations should focus on this high-risk group.
癌症患者在治疗过程中存在非计划性住院的风险，这会增加医疗保健成本。
确定与临床试验参与者医疗保健利用和成本相关的人口统计学和临床因素。
设计、地点和患者：我们对 1999 年至 2011 年间在 SWOG 临床试验中接受治疗的 65 岁以上乳腺癌患者进行了回顾性分析，试验数据与医疗保险索赔相关联。
结果是医疗保险索赔中的医疗保健利用（急诊就诊 (ER)、住院）和成本。从临床试验记录中获取人口统计学、临床和预后因素。我们从医疗保险索赔中确定了心血管合并症/风险因素（CVD-RFs），包括糖尿病、高血压、高胆固醇血症和冠心病 (CAD)。多变量逻辑和线性回归用于评估 CVD-RFs 与结果之间的关联。
在纳入分析的 708 名患者中，160 名（22.6%）经历了 234 次单独住院，193 名（27.3%）经历了 311 次单独急诊就诊。与白种人相比，黑种人住院的风险增加（比值比 [95%置信区间]，2.52 [1.10-5.79]，p=0.03），但急诊就诊的风险没有增加。糖尿病、高血压、高胆固醇血症和 CAD 均与住院和急诊就诊风险增加独立相关。高血压的关联最强，与无高血压的患者相比，高血压患者的住院风险增加了三倍以上（比值比 [95%置信区间]，3.16 [1.85-5.40]，p<0.001）。对于有≥3 个 RFs 的患者，与有 0 个或 1 个 CVD-RFs 的患者相比，住院风险增加了近 3 倍（比值比 [95%置信区间]，2.74 [1.71-4.38]，p<0.001）。急诊就诊也有类似的结果。在试验注册后的前 12 个月，患有糖尿病的患者（$38324 美元与$30923 美元，增加 23.9%，p=0.05）、高胆固醇血症患者（$34168 美元与$30661 美元，增加 11.4%，p=0.02）和冠心病患者（$37781 美元与$31698 美元，增加 19.2%，p=0.04）的总医疗保健费用有统计学显著增加。此外，有≥2 个显著 CVD-RFs 的患者（$35353 美元与$28899 美元，增加 22.3%，p=0.005）的总医疗保健费用也有统计学显著增加。
在接受临床试验治疗的参与者中，黑种人和存在多种心血管合并症与急诊就诊、住院和医疗保健费用的大幅增加有关。减少非计划性住院的努力应集中在这一高风险群体。
