Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; and.
Yale University School of Medicine, New Haven, Connecticut.
J Natl Compr Canc Netw. 2020 Oct 1;18(10):1349-1353. doi: 10.6004/jnccn.2020.7574. Print 2020 Oct.
The cost of cancer treatment has increased significantly in recent decades, but it is unclear whether these costs have been associated with commensurate improvement in clinical value. This study aimed to assess the association between the cost of cancer treatment and 4 of the 5 NCCN Evidence Blocks (EB) measures of clinical value: efficacy of regimen/agent, safety of regimen/agent, quality of evidence, and consistency of evidence.
This is a cross-sectional, observational study. We obtained NCCN EB ratings for all recommended, first-line, and/or maintenance treatments for the 30 most prevalent cancers in the United States and calculated direct pharmacologic treatment costs (drug acquisition, administration fees, guideline-concordant supportive care medications) using Medicare reimbursement rates in January 2019. We used generalized estimating equations to estimate the association between NCCN EB measures and treatment cost with clustering at the level of the treatment indication.
A total of 1,386 treatments were included. Among time-unlimited treatments (those administered on an ongoing basis without a predetermined stopping point), monthly cost was positively associated with efficacy ($3,036; 95% CI, $1,782 to $4,289) and quality of evidence ($1,509; 95% CI, $171 to $2,847) but negatively associated with safety (-$1,470; 95% CI, -$2,790 to -$151) and consistency of evidence (-$2,003; 95% CI, -$3,420 to -$586). Among time-limited treatments (those administered for a predetermined interval or number of cycles), no NCCN EB measure was significantly associated with treatment cost.
An association between NCCN EB measures and treatment cost was inconsistent, and the magnitude of the association was small compared with the degree of cost variation among treatments with the same EB scores. The clinical value of cancer treatments does not seem to be a primary determinant of treatment cost.
近几十年来，癌症治疗的成本显著增加，但尚不清楚这些成本是否与临床价值的相应提高有关。本研究旨在评估癌症治疗成本与 NCCN 证据块（EB）的 5 个临床价值衡量标准中的 4 个之间的关联：治疗方案/药物的疗效、治疗方案/药物的安全性、证据质量和证据一致性。
这是一项横断面、观察性研究。我们获得了美国 30 种最常见癌症的所有推荐、一线和/或维持治疗的 NCCN EB 评分，并使用 2019 年 1 月的医疗保险报销率计算了直接药物治疗成本（药物获取、管理费用、符合指南的支持性护理药物）。我们使用广义估计方程来估计 NCCN EB 措施与治疗成本之间的关联，并在治疗指征水平上进行聚类。
共纳入 1386 种治疗方法。在无时间限制的治疗方法（持续进行且无预定停止点的治疗方法）中，每月成本与疗效呈正相关（$3036；95%CI，$1782 至 $4289）和证据质量呈正相关（$1509；95%CI，$171 至 $2847），但与安全性呈负相关（$-1470；95%CI，$-2790 至 -$151）和证据一致性呈负相关（$-2003；95%CI，$-3420 至 -$586）。在有时间限制的治疗方法（在预定的间隔或周期内进行的治疗方法）中，没有 NCCN EB 措施与治疗成本显著相关。
NCCN EB 措施与治疗成本之间的关联不一致，与具有相同 EB 评分的治疗方法之间的成本差异相比，关联的幅度较小。癌症治疗的临床价值似乎不是治疗成本的主要决定因素。
