Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Switzerland.
J Surg Oncol. 2021 Mar;123(4):1023-1029. doi: 10.1002/jso.26390. Epub 2021 Jan 26.
To evaluate the economic burden of locally advanced rectal cancer (LARC) treatment from a society perspective through analysis of health insurance-derived data of commercially insured and Medicare Advantage (MA) patients.
Retrospective cost analysis of patients undergoing rectal resection within a multimodal (neoadjuvant chemoradiation + adjuvant chemotherapy) treatment strategy between January 1, 2010 and October 31, 2018, using the claims OptumLabs Data Warehouse database.
In total, 1738 (935 commercial and 803 MA) patients were included. Overall treatment costs totaled $230,881,746 (on average $183 653 ± 82 384 per commercially insured and $73 681 ± 32 917 per MA patient). Cost distribution according to category (commercially insured patients) was: 29.92% related to outpatient care (follow-up visits/diagnostics), radiotherapy: 21.83%, index resection: 20.62%, chemotherapy: 17.44%, surgical inpatient: 6.32%, medical inpatient: 3.28%, emergency room: 0.58%. Relative cost distribution of the index resection itself differed marginally between the three approaches and was 21.49% for open, 19.30% for laparoscopic, and 20.93% for robotic surgery. Relative cost distributions of neoadjuvant, adjuvant, and outpatient treatments remained unchanged, independently of the surgical approach. This representation was similar in MA patients.
Index-surgery related costs were outweighed by costs related to oncological and outpatient workup/follow-up treatments independently of both surgical approach and insurance type.
通过分析商业保险和医疗保险优势（MA）患者的健康保险数据，从社会角度评估局部晚期直肠癌（LARC）治疗的经济负担。
使用 OptumLabs Data Warehouse 索赔数据库，对 2010 年 1 月 1 日至 2018 年 10 月 31 日期间接受多模式治疗（新辅助放化疗+辅助化疗）的直肠切除术患者进行回顾性成本分析。
共纳入 1738 例（935 例商业保险和 803 例 MA）患者。总治疗费用为 230881746 美元（商业保险患者平均费用为 183653±82384 美元，MA 患者为 73681±32917 美元）。根据类别（商业保险患者）的成本分布为：29.92%与门诊护理（随访/诊断）有关，放疗占 21.83%，指数切除术占 20.62%，化疗占 17.44%，手术住院治疗占 6.32%，住院治疗占 3.28%，急诊室占 0.58%。三种方法之间指数切除术本身的相对成本分布略有不同，开放式手术为 21.49%，腹腔镜手术为 19.30%，机器人手术为 20.93%。新辅助治疗、辅助治疗和门诊治疗的相对成本分布不受手术方法的影响。MA 患者也有类似的表现。
指数手术相关成本被肿瘤学和门诊检查/随访治疗相关成本所抵消，独立于手术方法和保险类型。
