在一个多样化的基于人群的队列中，乳房切除术后乳房重建相关的经济衰退感知。
Perceived financial decline related to breast reconstruction following mastectomy in a diverse population-based cohort.
机构信息
Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan.
National Clinician Scholars Program, Institute for Health Policy and Innovation, Ann Arbor, Michigan.
出版信息
Cancer. 2022 Mar 15;128(6):1284-1293. doi: 10.1002/cncr.34048. Epub 2021 Nov 30.
BACKGROUND
Despite mandated insurance coverage for breast reconstruction following mastectomy, health care costs are increasingly passed on to women through cost-sharing arrangements and high-deductible health plans. In this population-based study, the authors assessed perceived financial and employment declines related to breast reconstruction following mastectomy.
METHODS
Women with early-stage breast cancer (stages 0-II) diagnosed between July 2013 and May 2015 who underwent mastectomy were identified through the Surveillance, Epidemiology, and End Results registries of Georgia and Los Angeles and were surveyed. Primary outcome measures included patients' appraisal of their financial and employment status after cancer treatment. Multivariable models evaluated the association between breast reconstruction and primary outcomes.
RESULTS
Among 883 patients with breast cancer who underwent mastectomy, 44.2% did not undergo breast reconstruction, and 55.8% underwent reconstruction. Overall, 21.9% of the cohort reported being worse off financially since their diagnosis (25.8% with reconstruction vs 16.6% without reconstruction; P = .002). Women who underwent reconstruction reported higher out-of-pocket medical expenses (32.1% vs 15.6% with expenses greater than $5000; P < .001). Reconstruction was independently associated with a perceived decline in financial status (odds ratio, 1.92; 95% confidence interval, 1.15-3.22; P = .013). Among women who were employed at the time of their diagnosis, there was no association between reconstruction and a perceived decline in employment status (P = .927).
CONCLUSIONS
In this diverse cohort of women who underwent mastectomy, those who elected to undergo reconstruction experienced higher out-of-pocket medical expenses and self-reported financial decline. Patients, providers, and policymakers should be aware of the potential financial implications related to reconstruction despite mandatory insurance coverage.
背景
尽管强制性医疗保险涵盖了乳房重建，但医疗费用却越来越多地通过共付额安排和高免赔额健康计划转嫁给了女性。在这项基于人群的研究中，作者评估了乳房切除术后乳房重建与感知到的财务和就业下降之间的关系。
方法
通过佐治亚州和洛杉矶的监测、流行病学和最终结果登记处确定了在 2013 年 7 月至 2015 年 5 月期间被诊断患有早期乳腺癌（0-2 期）并接受乳房切除术的女性，并对其进行了调查。主要结局指标包括患者对癌症治疗后财务和就业状况的评估。多变量模型评估了乳房重建与主要结局之间的关系。
结果
在 883 名接受乳房切除术的乳腺癌患者中，44.2%的患者未进行乳房重建，55.8%的患者进行了重建。总体而言，该队列中有 21.9%的患者表示自诊断以来经济状况恶化（重建组为 25.8%，未重建组为 16.6%；P=0.002）。接受重建的女性报告医疗费用自付额更高（32.1%比费用超过 5000 美元的 15.6%；P<0.001）。重建与财务状况下降的感知独立相关（比值比，1.92；95%置信区间，1.15-3.22；P=0.013）。在诊断时就业的女性中，重建与就业状况下降的感知之间没有关联（P=0.927）。
结论
在接受乳房切除术的不同种族女性队列中，选择接受重建的女性自付医疗费用更高，并自我报告经济状况下降。尽管有强制性医疗保险覆盖，但患者、提供者和决策者应该意识到与重建相关的潜在经济影响。
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