利用趋势和医疗保险支出的短期放射治疗乳腺癌和前列腺癌:基于事件的分析从 2015 年到 2019 年。
Trends in Utilization and Medicare Spending on Short-Course Radiation Therapy for Breast and Prostate Cancer: An Episode-Based Analysis From 2015 to 2019.
机构信息
Department of Healthcare Management and Policy, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Health Policy, Stanford University School of Medicine, Stanford, California.
出版信息
Int J Radiat Oncol Biol Phys. 2024 May 1;119(1):17-22. doi: 10.1016/j.ijrobp.2023.11.043. Epub 2023 Dec 8.
PURPOSE
Evidence supports the value of shorter, similarly efficacious, and potentially more cost-effective hypofractionated radiation therapy (RT) regimens in many clinical scenarios for breast cancer (BC) and prostate cancer (PC). However, practice patterns vary considerably. We used the most recent Centers for Medicare and Medicaid Services data to assess trends in RT cost and practice patterns among episodes of BC and PC.
METHODS AND MATERIALS
We performed a retrospective cohort analysis of all external beam RT episodes for BC and PC from 2015 to 2019 to assess predictors of short-course RT (SCRT) use and calculated spending differences. Multivariable logistic regression defined adjusted odds ratios of receipt of SCRT over longer-course RT (LCRT) by treatment modality, age, year of diagnosis, type of practice, and the interaction between year and treatment setting. Medicare spending was evaluated using multivariable linear regression controlling for duration of RT regimen (SCRT vs LCRT) in addition to the above covariables.
RESULTS
Of 143,729 BC episodes and 114,214 PC episodes, 63,623 (44.27%) and 25,955 (22.72%) were SCRT regimens, respectively. Median total spending for SCRT regimens among BC episodes was $9418 (interquartile range [IQR], $7966-$10,983) versus $13,602 (IQR, $11,814-$15,499) for LCRT. Among PC episodes, median total spending was $6924 (IQR, $4,509-$12,905) for stereotactic body RT, $18,768 (IQR, $15,421-$20,740) for moderate hypofractionation, and $27,319 (IQR, $25,446-$29,421) for LCRT. On logistic regression, receipt of SCRT was associated with older age among both BC and PC episodes as well as treatment at hospital-affiliated over freestanding sites (P < .001 for all).
CONCLUSIONS
In this evaluation of BC and PC RT episodes from 2015 to 2019, we found that shorter-course RT resulted in lower costs than longer-course RT. SCRT was also more common in hospital-affiliated sites. Future research focusing on potential payment incentives encouraging SCRT when clinically appropriate in the 2 most common cancers treated with RT will be valuable as the field continues to prospectively evaluate cost-effective hypofractionation in other disease sites.
目的
有证据表明，在许多乳腺癌（BC）和前列腺癌（PC）的临床情况下，较短、疗效相似且潜在更具成本效益的适形分割放射治疗（RT）方案具有价值。然而，实践模式差异很大。我们利用最近的医疗保险和医疗补助服务中心的数据，评估了 BC 和 PC 治疗期间 RT 成本和实践模式的变化趋势。
方法和材料
我们对 2015 年至 2019 年所有 BC 和 PC 的外照射 RT 治疗进行了回顾性队列分析，以评估短程 RT（SCRT）的使用预测因素，并计算了支出差异。多变量逻辑回归通过治疗方式、年龄、诊断年份、实践类型以及年份与治疗环境之间的相互作用，确定了 SCRT 与长程 RT（LCRT）相比的调整后 SCRT 使用率的比值比。在控制 RT 方案持续时间（SCRT 与 LCRT）的基础上，利用多变量线性回归评估了 Medicare 支出，除了上述协变量外，还进行了调整。
结果
在 143729 例 BC 病例和 114214 例 PC 病例中，63623 例（44.27%）和 25955 例（22.72%）分别采用 SCRT 方案。BC 病例中 SCRT 方案的中位总支出为 9418 美元（四分位距 [IQR]，7966 美元-10983 美元），而 LCRT 的中位总支出为 13602 美元（IQR，11814 美元-15499 美元）。在 PC 病例中，立体定向体部 RT 的中位总支出为 6924 美元（IQR，4509 美元-12905 美元），中度适形分割的中位总支出为 18768 美元（IQR，15421 美元-20740 美元），LCRT 的中位总支出为 27319 美元（IQR，25446 美元-29421 美元）。在逻辑回归中，BC 和 PC 病例中 SCRT 的接受与年龄较大以及医院附属机构而非独立机构治疗有关（所有 P <.001）。
结论
在对 2015 年至 2019 年 BC 和 PC 的 RT 治疗进行评估后，我们发现，短程 RT 比长程 RT 成本更低。SCRT 也更常见于医院附属机构。未来的研究将聚焦于在临床适当的情况下，为治疗最常见的两种癌症提供潜在的支付激励措施，鼓励使用 SCRT，这将是有价值的，因为该领域将继续前瞻性地评估其他疾病部位的更具成本效益的适形分割。
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