Brick Rachelle, Williams Courtney P, Deng Luqin, Mollica Michelle A, Stout Nicole, Gorzelitz Jessica
Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD.
Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL.
Arch Phys Med Rehabil. 2024 Dec;105(12):2301-2308. doi: 10.1016/j.apmr.2024.08.002. Epub 2024 Aug 21.
To examine the association between rehabilitation utilization within 12 months of breast cancer diagnosis and out-of-pocket costs in the second year (12-24mo after diagnosis).
Secondary analysis of the 2009-2019 Surveillance, Epidemiology and End Results-Medicare linked database. Individuals who received rehabilitation services were propensity-score matched to individuals who did not receive services. Overall and health care service-specific models were examined using generalized linear models with a gamma distribution.
Inpatient and outpatient medical facilities.
A total of 35,212 individuals diagnosed with nonmetastatic breast cancer and were continuously enrolled in Medicare Fee-For Service (parts A, B, and D) in the 12 months before and 24 months postdiagnosis.
Not applicable.
Individual cost responsibility, a proxy for out-of-pocket costs, which was defined as deductibles, coinsurance, and copayments during the second year after diagnosis (12-24mo postdiagnosis).
The mean individual cost responsibility was higher in individuals who used rehabilitation than those who did not ($4013 vs $3783), although it was not a clinically meaningful difference (d=0.06). Individuals who received rehabilitative services had significantly higher costs attributed to individual provider care ($1634 vs $1476), institutional outpatient costs ($886 vs $812), and prescription drugs ($959 vs $906), and significantly lower costs attributed to institutional inpatient costs ($455 vs $504), and durable medical equipment ($81 vs $86).
Older adults with breast cancer who received rehabilitation services had higher cost responsibility during the second year after diagnosis than those who did not. Future work is needed to examine the relationship between rehabilitation and out-of-pocket costs across longer periods of time and in conjunction with perceived benefit.
研究乳腺癌诊断后12个月内康复治疗的使用情况与第二年（诊断后12 - 24个月）自付费用之间的关联。
对2009 - 2019年监测、流行病学和最终结果 - 医疗保险关联数据库进行二次分析。接受康复服务的个体与未接受服务的个体进行倾向得分匹配。使用具有伽马分布的广义线性模型检查总体和特定医疗服务模型。
住院和门诊医疗设施。
共有35212名被诊断为非转移性乳腺癌的个体，在诊断前12个月和诊断后24个月持续参加医疗保险按服务付费计划（A、B和D部分）。
不适用。
个体费用责任，作为自付费用的替代指标，定义为诊断后第二年（诊断后12 - 24个月）的免赔额、共保费用和自付费用。
使用康复治疗的个体的平均个体费用责任高于未使用康复治疗的个体（4013美元对3783美元），尽管这在临床上并非有意义的差异（d = 0.06）。接受康复服务的个体在个体提供者护理方面的费用显著更高（1634美元对1476美元）、机构门诊费用（886美元对812美元）和处方药费用（959美元对906美元），而在机构住院费用（455美元对504美元）和耐用医疗设备费用（81美元对86美元）方面的费用显著更低。
接受康复服务的老年乳腺癌患者在诊断后第二年的费用责任高于未接受康复服务的患者。未来需要开展工作，以研究更长时间段内康复治疗与自付费用之间的关系，并结合感知到的益处进行研究。
