Department of Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands.
Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands.
J Geriatr Oncol. 2024 Sep;15(7):102046. doi: 10.1016/j.jgo.2024.102046. Epub 2024 Aug 12.
The Value-Based Health Care (VBHC) model of care provides insights into patient characteristics, outcomes, and costs of care delivery that help clinicians counsel patients. This study compares the allocation and value of curative oncological treatment in frail and fit older patients with esophageal cancer in a dedicated VBHC pathway.
Data was collected from patients with primary esophageal cancer without distant metastases, aged 70 years or older, and treated at a Dutch tertiary care hospital between 2015 and 2019. Geriatric assessment (GA) was performed. Outcomes included treatment discontinuation, mortality, quality of life (QoL), and physical functioning over a one-year period. Direct hospital costs were estimated using activity-based costing.
In this study, 89 patients were included with mean age 75 years. Of 56 patients completing GA, 19 were classified as frail and 37 as fit. For frail patients, the treatment plan was chemoradiotherapy and surgery (CRT&S) in 68% (13/19) and definitive chemoradiotherapy (dCRT) in 32% (6/19); for fit patients, CRT&S in 84% (31/37) and dCRT in 16% (6/37). Frail patients discontinued chemotherapy more often than fit patients (26% (5/19) vs 11% (4/37), p = 0.03) and reported lower QoL after six months (mean 0.58 [standard deviation (SD) 0.35] vs 0.88 [0.25], p < 0.05). After one year, 11% of frail and 30% of fit patients reported no decline in physical functioning and QoL and survived. Frail and fit patients had comparable mean direct hospital costs (€24 K [SD €13 K] vs €23 K [SD €8 K], p = 0.82).
The value of curative oncological treatment was lower for frail than for fit patients because of slightly worse outcomes and comparable costs. The utility of the VBHC model of care depends on the availability of sufficient data. Real-world evidence in VBHC can be used to inform treatment decisions and optimization in future patients by sharing results and monitoring performance over time.
The study was retrospectively registered at the Netherlands Trial Register (NTR), trial number NL8107 (date of registration: 22-10-2019).
基于价值的医疗保健（VBHC）护理模式提供了有关患者特征、护理结果和成本的见解，有助于临床医生为患者提供咨询。本研究比较了在专门的 VBHC 途径中，虚弱和健康的老年食管癌患者的治疗分配和治疗效果。
收集了 2015 年至 2019 年期间在荷兰一家三级护理医院接受治疗的无远处转移、年龄 70 岁或以上的原发性食管癌患者的数据。进行了老年评估（GA）。结果包括治疗中断、死亡率、一年期间的生活质量（QoL）和身体功能。使用基于活动的成本法估算直接住院费用。
本研究纳入 89 例患者，平均年龄 75 岁。56 例完成 GA 的患者中，19 例被归类为虚弱，37 例为健康。对于虚弱的患者，治疗方案为放化疗和手术（CRT&S）的占 68%（13/19），单纯放化疗（dCRT）的占 32%（6/19）；对于健康的患者，CRT&S 的占 84%（31/37），dCRT 的占 16%（6/37）。与健康的患者相比，虚弱的患者更常停止化疗（26%（5/19）比 11%（4/37），p=0.03），且在六个月后 QoL 较低（平均 0.58[标准差（SD）0.35]比 0.88[0.25]，p<0.05）。一年后，11%的虚弱患者和 30%的健康患者报告身体功能和 QoL 没有下降且存活。虚弱和健康的患者的直接住院费用相当（€24K[SD €13K]比 €23K[SD €8K]，p=0.82）。
由于结果略差且成本相当，因此，虚弱患者的治疗效果低于健康患者。基于价值的医疗保健模式的效用取决于是否有足够的数据。基于价值的真实世界证据可以通过分享结果和随时间监测绩效来为未来的患者提供治疗决策和优化方面的信息。
该研究在荷兰试验注册中心（NTR）进行了回顾性注册，注册号 NL8107（注册日期：2019 年 10 月 22 日）。
