捕获乳腺癌治疗的真实成本：基于分子亚型和分期的每例活动成本核算。

Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing.

机构信息

Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada.

Department of Radiology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada.

出版信息

Curr Oncol. 2023 Aug 26;30(9):7860-7873. doi: 10.3390/curroncol30090571.

DOI:10.3390/curroncol30090571

PMID:37754486

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10527628/

Abstract

BACKGROUND

Breast cancer (BC) treatment is rapidly evolving with new and costly therapeutics. Existing costing models have a limited ability to capture current treatment costs. We used an Activity-Based Costing (ABC) method to determine a per-case cost for BC treatment by stage and molecular subtype.

METHODS

ABC was used to proportionally integrate multidisciplinary evidence-based patient and provider treatment options for BC, yielding a per-case cost for the total duration of treatment by stage and molecular subtype. Diagnostic imaging, pathology, surgery, radiation therapy, systemic therapy, inpatient, emergency, home care and palliative care costs were included.

RESULTS

BC treatment costs were higher than noted in previous studies and varied widely by molecular subtype. Cost increased exponentially with the stage of disease. The per-case cost for treatment (2023C$) for DCIS was C$ 14,505, and the mean costs for all subtypes were C$ 39,263, C$ 76,446, C$ 97,668 and C$ 370,398 for stage I, II, III and IV BC, respectively. Stage IV costs were as high as C$ 516,415 per case. When weighted by the proportion of molecular subtype in the population, case costs were C$ 31,749, C$ 66,758, C$ 111,368 and C$ 289,598 for stage I, II, III and IV BC, respectively. The magnitude of cost differential was up to 10.9 times for stage IV compared to stage I, 4.4 times for stage III compared to stage I and 35.6 times for stage IV compared to DCIS.

CONCLUSION

The cost of BC treatment is rapidly escalating with novel therapies and increasing survival, resulting in an exponential increase in treatment costs for later-stage disease. We provide real-time, case-based costing for BC treatment which will allow for the assessment of health system economic impacts and an accurate understanding of the cost-effectiveness of screening.

摘要

背景

乳腺癌（BC）的治疗方法正在迅速发展，出现了许多新的、昂贵的治疗方法。现有的成本模型在捕捉当前治疗成本方面的能力有限。我们使用作业成本法（ABC）来确定按阶段和分子亚型划分的 BC 治疗的每例成本。

方法

ABC 用于按比例整合多学科循证患者和提供者的 BC 治疗选择，得出按阶段和分子亚型划分的整个治疗期间的每例成本。诊断成像、病理学、手术、放射治疗、系统治疗、住院、急诊、家庭护理和姑息治疗费用均包括在内。

结果

BC 治疗费用高于以往研究中的报道，且因分子亚型而异。成本随疾病阶段呈指数级增长。DCIS 的每例治疗费用（2023 加元）为 14505 加元，所有亚型的平均费用分别为 I 期、II 期、III 期和 IV 期 BC 的 39263 加元、76446 加元、97668 加元和 370398 加元。IV 期成本高达每例 516415 加元。按人群中分子亚型的比例加权后，I、II、III 和 IV 期 BC 的每例费用分别为 31749 加元、66758 加元、111368 加元和 289598 加元。IV 期与 I 期相比，成本差异高达 10.9 倍，III 期与 I 期相比为 4.4 倍，IV 期与 DCIS 相比为 35.6 倍。