Ng Ayesha P, Sanaiha Yas, Verma Arjun, Lee Cory, Akhavan Aaron, Cohen Joshua G, Benharash Peyman
Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
Gynecol Oncol. 2022 Aug;166(2):200-206. doi: 10.1016/j.ygyno.2022.05.017. Epub 2022 Jun 2.
To evaluate the risk of financial toxicity (FT) among inpatients undergoing gynecologic cancer resections and the association of insurance status with clinical and financial outcomes.
Using the 2008-2019 National Inpatient Sample, we identified adult hospitalizations for hysterectomy or oophorectomy with a diagnosis of cancer. Hospitalization costs, length of stay (LOS), mortality, and complications were assessed by insurance status. Risk of FT was defined as health expenditure exceeding 40% of post-subsistence income. Multivariable regressions were used to analyze costs and factors associated with FT risk.
Of 462,529 patients, 49.4% had government-funded insurance, 44.3% private, and 3.2% were uninsured. Compared to insured, uninsured patients were more commonly Black and Hispanic, admitted emergently, and underwent open operations. Uninsured patients experienced similar mortality but greater rates of complications, LOS, and costs. Overall, ovarian cancer resections had the highest median costs of $17,258 (interquartile range: 12,187-25,491) compared to cervical and uterine. Approximately 52.8% of uninsured and 15.4% of insured patients were at risk of FT. As costs increased across both cohorts over the 12-year study period, the disparity in FT risk by payer status broadened. After risk adjustment, perioperative complications were associated with nearly 2-fold increased risk of FT among uninsured (adjusted odds ratio 1.75, 95% confidence interval 1.46-2.09, p < 0.001). Among the insured, Black and Hispanic race, public insurance, and open operative approach exhibited greater odds of FT.
Patients undergoing gynecologic cancer operations are at substantial risk of FT, particularly those uninsured. Targeted cost-mitigation strategies are warranted to minimize financial burden.
评估接受妇科癌症切除术的住院患者发生经济毒性（FT）的风险，以及保险状况与临床和经济结局之间的关联。
利用2008 - 2019年全国住院患者样本，我们确定了诊断为癌症的子宫切除术或卵巢切除术的成年住院病例。通过保险状况评估住院费用、住院时间（LOS）、死亡率和并发症。FT风险定义为医疗支出超过维持生计后收入的40%。采用多变量回归分析成本及与FT风险相关的因素。
在462,529例患者中，49.4%有政府资助保险，44.3%有私人保险，3.2%无保险。与有保险的患者相比，无保险患者更常见为黑人和西班牙裔，急诊入院，且接受开放性手术。无保险患者死亡率相似，但并发症发生率、住院时间和费用更高。总体而言，与宫颈癌和子宫癌切除术相比，卵巢癌切除术的中位费用最高，为17,258美元（四分位间距：12,187 - 25,491美元）。约52.8%的无保险患者和15.4%的有保险患者有FT风险。在12年研究期间，随着两个队列的费用增加，支付者状态导致的FT风险差异扩大。风险调整后，围手术期并发症与无保险患者FT风险增加近2倍相关（调整优势比1.75，95%置信区间1.46 - 2.09，p < 0.001）。在有保险的患者中，黑人和西班牙裔种族、公共保险和开放性手术方式FT风险更高。
接受妇科癌症手术的患者有发生FT的重大风险，尤其是那些无保险的患者。有必要采取针对性的成本降低策略，以尽量减轻经济负担。
