Department of Radiation Oncology, Stanford University, 875 Blake Wilbur Dr, Palo Alto, CA, 94304, USA.
Transitional Year Residency Program, Gundersen Health System, La Crosse, WI, USA.
Support Care Cancer. 2022 Feb;30(2):1703-1713. doi: 10.1007/s00520-021-06584-0. Epub 2021 Sep 26.
Adolescents and young adults (AYA) with cancer are at risk of high cumulative healthcare system costs potentially associated with poor health and financial outcomes. Although this has been studied at academic centers, little data on AYA costs at community-based practices exist. The goals of this study were to understand direct health care costs for AYA patients, identify factors for high costs, and assess how total health care costs may relate to survival.
AYA patients (15-39 years) treated at a community hospital in Wisconsin (USA) between 2005 and 2020 were identified. Patient demographics, cancer characteristics, therapies, support services, and all direct health care charges (including up to 1 year prior to diagnosis to capture any diagnostic workup) were collected. Logistic and Cox proportional hazard regression models identified factors associated with high costs and survival, respectively.
The 388 AYA patients had a median follow-up of 9 years (97% survival). Most were 30-39 years (62%), female (61%), white (95%), diagnosed early-stage (85%), and underwent surgery (83%). Complete health care costs were available for 233 patients (60%). Median total costs per patient were $123 K (range, $73-$215 K). On adjusted analysis, higher direct health care costs (> $125 K) were associated with greater odds of hospital admissions (odds ratio [OR] = 1.7, 95% CI = 1.35-2.27), chemotherapy (OR = 4.1, 95% CI = 1.44-12.70), and breast cancer diagnosis (OR = 3.8, 95% CI = 1.07-14.70). Living farther from the hospital (OR = 0.1, 95% CI = 0.02-0.50), later year of diagnosis (OR = 0.7, 95% CI = 0.55-0.77), and uninsured/unknown insurance status (OR = 0.1, 95% CI = 0.01-0.57) were associated with decreased odds of having higher health care costs. On adjusted analysis, death was associated with greater odds of higher direct health care costs per $125 K (hazards ratio [HR] = 7.9, 95% CI = 2.22-27.80) and radiation (HR = 31.8, 95% CI = 3.15-321) but lower odds of hormone therapy (HR = 0.1, 95% CI = 0.01-0.72) and later year of diagnosis (HR = 0.3, 95% CI = 0.12-0.60).
High direct health care costs among AYA patients are associated with hospital admissions, chemotherapy, breast cancer diagnosis, hospital proximity, and earlier year of diagnosis. Death was associated with high direct health care costs, earlier years of diagnosis, and radiation therapy. Total health care costs in community-based hospitals should be considered in the context of AYA patients with cancer.
患有癌症的青少年和年轻人（AYA）存在潜在高额累积医疗保健系统成本的风险，这些成本可能与健康状况不佳和经济结果有关。尽管在学术中心已经对这一问题进行了研究，但在社区实践中关于 AYA 成本的数据却很少。本研究的目的是了解 AYA 患者的直接医疗保健成本，确定高成本的因素，并评估总医疗保健成本与生存之间的关系。
在威斯康星州（美国）的一家社区医院，确定了 2005 年至 2020 年间治疗的 AYA 患者。收集了患者的人口统计学特征、癌症特征、治疗方法、支持服务以及所有直接医疗保健费用（包括诊断前最多 1 年，以捕捉任何诊断性检查）。逻辑和 Cox 比例风险回归模型分别确定了与高成本和生存相关的因素。
388 名 AYA 患者的中位随访时间为 9 年（97%的生存率）。大多数患者年龄在 30-39 岁（62%），女性（61%），白人（95%），早期诊断（85%），并接受了手术（83%）。有 233 名患者（60%）的完整直接医疗保健费用可用。每位患者的中位总费用为 123 万美元（范围为 73-215 万美元）。在调整后的分析中，较高的直接医疗保健费用（>125 万美元）与住院（优势比[OR]为 1.7，95%置信区间[CI]为 1.35-2.27）、化疗（OR 为 4.1，95%CI 为 1.44-12.70）和乳腺癌诊断（OR 为 3.8，95%CI 为 1.07-14.70）的可能性更大。离医院较远（OR 为 0.1，95%CI 为 0.02-0.50）、诊断年份较晚（OR 为 0.7，95%CI 为 0.55-0.77）以及无保险/未知保险状况（OR 为 0.1，95%CI 为 0.01-0.57）与较低的高医疗保健费用可能性相关。在调整后的分析中，死亡与每 12.5 万美元的更高直接医疗保健费用（风险比[HR]为 7.9，95%CI 为 2.22-27.80）和放疗（HR 为 31.8，95%CI 为 3.15-321）的可能性更大相关，但激素治疗（HR 为 0.1，95%CI 为 0.01-0.72）和诊断年份较晚（HR 为 0.3，95%CI 为 0.12-0.60）的可能性较小。
AYA 患者的直接医疗保健费用较高与住院、化疗、乳腺癌诊断、医院接近度和较早的诊断年份有关。死亡与较高的直接医疗保健费用、较早的诊断年份和放射治疗有关。在考虑社区医院的 AYA 癌症患者时，应考虑总医疗保健费用。
