乳腺癌相关性淋巴水肿及其治疗：经济影响有多大？
Breast cancer-related lymphedema and its treatment: how big is the financial impact?
机构信息
Department of Rehabilitation Sciences, KU Leuven - University of Leuven, O&N IV Herestraat 49, box 1510, 3000, Leuven, Belgium.
Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
出版信息
Support Care Cancer. 2021 Jul;29(7):3801-3813. doi: 10.1007/s00520-020-05890-3. Epub 2020 Nov 24.
PURPOSE
Decongestive lymphatic treatment (DLT) is still the gold standard for treatment of breast cancer-related lymphedema (BCRL). With up to 17% of the patients treated for breast cancer developing BCRL, this morbidity imposes a tremendous financial burden for patients and society. Knowledge about this economic burden related to BCRL and its conservative treatment in a European setting is lacking. The aim of this prospective, longitudinal cohort study was to estimate the direct healthcare costs related to BCRL and its treatment in a European setting.
METHODS
Patients with BCRL were treated with DLT consisting of an intensive treatment phase of 3 weeks, followed by a maintenance treatment phase of 6 months. Additionally, the follow-up period comprised 6 months. During these 3 weeks and 12 months, all direct costs associated with the treatment of BCRL and its sequelae were documented through billing prices and a self-developed questionnaire which was administered after the intensive treatment phase, and subsequently 3-monthly during the entire period.
RESULTS
A total of 194 patients were enrolled in this study. Of these, 17% (n = 32) showed lymphedema stage I, 56% (n = 109) had lymphedema stage IIa, and 27% (n = 53) had lymphedema stage IIb. Total direct healthcare costs per patient were €2248.93 on average during the entire period of 3 weeks of intensive treatments and 12 months of maintenance decongestive therapy. Within these mean direct costs, €1803.35 (80%) was accounted for statutory health insurances, and €445.58 (20%) was out-of-pocket expenses for patients.
CONCLUSION
This study is one of the first standardized high-quality health economic analyses of BRCL treatment in Europe. The present study indicates that the price tag of BCRL treatment in Belgium is high not only for the health insurance but also for the patients Clinical trial registration number The study makes part of a double-blind, multi-center, randomized controlled trial (EFforT-BCRL trial), which is registered in clinicaltrials.gov (NCT02609724). CME reference S58689, EudraCT Number 2015-004822-33.
目的
消肿淋巴治疗（DLT）仍然是治疗乳腺癌相关淋巴水肿（BCRL）的金标准。高达 17%接受乳腺癌治疗的患者会出现 BCRL，这种发病率给患者和社会带来了巨大的经济负担。关于欧洲环境下这种疾病的经济负担以及保守治疗的相关知识尚不清楚。本前瞻性、纵向队列研究旨在评估欧洲环境下 BCRL 及其治疗的直接医疗成本。
方法
患有 BCRL 的患者接受 DLT 治疗，包括 3 周的强化治疗阶段和 6 个月的维持治疗阶段。此外，随访期为 6 个月。在这 3 周和 12 个月期间，通过计费价格和在强化治疗阶段后以及随后在整个期间每 3 个月进行的自我开发问卷，记录与 BCRL 及其后遗症治疗相关的所有直接费用。
结果
本研究共纳入 194 例患者。其中，17%（n=32）为 I 期淋巴水肿，56%（n=109）为 IIa 期淋巴水肿，27%（n=53）为 IIb 期淋巴水肿。在整个 3 周强化治疗和 12 个月维持去充血治疗期间，每位患者的平均直接医疗保健总成本为 2248.93 欧元。在这些平均直接成本中，法定健康保险占 1803.35 欧元（80%），患者自付费用占 445.58 欧元（20%）。
结论
本研究是欧洲首例对 BCRL 治疗进行标准化高质量健康经济学分析的研究之一。本研究表明，比利时 BCRL 治疗的价格标签不仅对健康保险而且对患者来说都很高。临床试验注册号 该研究是一项双盲、多中心、随机对照试验（EFforT-BCRL 试验）的一部分，该试验在 clinicaltrials.gov 注册（NCT02609724）。继续教育学分参考 S58689，EudraCT 编号 2015-004822-33。
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