Aly Abdalla, Johnson Courtney, Doleh Yunes, Chirikov Viktor, Botteman Marc, Shenolikar Rahul, Hussain Arif
AstraZeneca, Gaithersburg, MD.
Pharmerit International, Bethesda, MD.
J Clin Pathw. 2020 May;6(4):51-60.
Urothelial carcinoma (UC) is generally diagnosed early and may incur significant lifetime costs. This study estimated, from the payer's perspective, the lifetime costs among patients diagnosed with UC according to stage at diagnosis.
This retrospective analysis of the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database identified patients ≥66 years with newly diagnosed UC from 2004-2013. Patients were followed from UC diagnosis to death or last follow-up to estimate lifetime costs. Costs were allocated to 3 phases: diagnosis (≤3 months after diagnosis), terminal (≤3 months before death), and continuation (months between diagnosis and terminal phases). Survival-adjusted lifetime costs (total and major UC-related) were estimated for patients with UC based on stage at diagnosis (stages 0 through IV) and in a subgroup of patients receiving ≥1 systemic line of chemotherapy (LOC).
The sample included 15,588 patients: 3,446 stage 0 (8% ≥1 LOC; median [IQR] follow-up in months: 44 [23-71]); 3,902 stage I (12% ≥1 LOC; 33 [15-62]); 4,301 stage II (26% ≥1 LOC; 17 [7-39]); 1,612 stage III (25% ≥1 LOC; 17 [7-42]); and 2,327 stage IV (33% ≥1 LOC; 8 [3-18]). Median age was 78 years and 72% were male. Mean lifetime costs were lowest for stage IV patients (stage 0, $151,626; stage 1, $150,123; stage II, $149,728; stage III, $190,996; stage IV, $117,503). Hospitalizations not involving a cystectomy contributed about half of lifetime costs across all stages. Cystectomy contributed 2-13% of the total lifetime UC costs ($3,356 stage 0; $7,011 stage I; $11,855 stage II; $25,509 stage III; $11,693 stage IV). UC-related office visits contributed 8-15% of lifetime costs ($11,717 stage 0; $14,611 stage I; $19,882 stage II; $21,480 stage III; $17,820 stage IV).
UC continues to be a costly cancer with stage III patients having highest lifetime costs. Hospitalizations drive most of the lifetime costs across all stages; most of these hospitalizations did not involve costs related to cystectomy. Treatment plans requiring shorter and fewer hospitalizations may lessen the economic burden of UC.
尿路上皮癌（UC）通常在早期被诊断出来，可能会产生高昂的终身费用。本研究从支付方的角度，根据诊断时的分期估算了UC患者的终身费用。
对关联的监测、流行病学和最终结果（SEER）-医疗保险数据库进行回顾性分析，确定了2004年至2013年期间年龄≥66岁的新诊断UC患者。从UC诊断开始随访至死亡或最后一次随访，以估算终身费用。费用分为三个阶段：诊断阶段（诊断后≤3个月）、终末期（死亡前≤3个月）和持续阶段（诊断阶段和终末期之间的月份）。根据诊断时的分期（0期至IV期）以及接受≥1线全身化疗（LOC）的患者亚组，估算了UC患者的生存调整后终身费用（总计和主要的UC相关费用）。
样本包括15588名患者：3446名0期患者（8%接受≥1线LOC；中位[IQR]随访月数：44[23 - 71]）；3902名I期患者（12%接受≥1线LOC；33[15 - 62]）；4301名II期患者（26%接受≥1线LOC；17[7 - 39]）；1612名III期患者（25%接受≥1线LOC；17[7 - 42]）；2327名IV期患者（33%接受≥1线LOC；8[3 - 18]）。中位年龄为78岁，72%为男性。IV期患者的平均终身费用最低（0期，151626美元；I期，150123美元；II期，149728美元；III期，190996美元；IV期，117503美元）。所有分期中，不涉及膀胱切除术的住院费用约占终身费用的一半。膀胱切除术占UC终身总费用的2% - 13%（0期3356美元；I期7011美元；II期11855美元；III期25509美元；IV期11693美元）。UC相关的门诊就诊费用占终身费用的8% - 15%（0期11717美元；I期14611美元；II期19882美元；III期21480美元；IV期17820美元）。
UC仍然是一种成本高昂的癌症，III期患者的终身费用最高。住院费用占所有分期终身费用的大部分；这些住院费用大多与膀胱切除术无关。需要缩短住院时间和减少住院次数的治疗方案可能会减轻UC的经济负担。
