早期子宫内膜癌短程辅助阴道穹窿近距离放疗较标准治疗的财务效益：SAVE 试验
Financial Improvements From Short Course Adjuvant Vaginal Cuff Brachytherapy in Early Endometrial Cancer Compared With Standard of Care, "SAVE" Trial.
机构信息
Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
Department of Medicine, University of Wisconsin, Madison, Wisconsin.
出版信息
Pract Radiat Oncol. 2024 Nov-Dec;14(6):e500-e506. doi: 10.1016/j.prro.2024.07.006. Epub 2024 Sep 13.
PURPOSE
Early-stage endometrial cancer is often treated with hysterectomy followed by adjuvant vaginal cuff brachytherapy (VCB). Financial toxicity from cancer treatment can impact treatment completion. The Short Course Adjuvant Vaginal Cuff Brachytherapy in Early Endometrial Cancer Compared to Standard of Care trial is a multicenter, prospective randomized trial of standard of care (SoC) VCB doses delivered in 3 to 5 fractions per the physician's discretion compared with a 2-fraction course. We report on secondary cost endpoints, quantifying the financial impacts of shorter treatment courses on institutions and participating patients.
METHODS AND MATERIALS
Technical (TechCs), professional, and total charges (TotCs) were collected prospectively and are reported as raw and Medicare-adjusted charges per patient. Distance to the treatment center and the median income for each patient's zip code were estimated. The Mann-Whitney U statistic, t test, and X test were used to compare characteristics between the 2 groups.
RESULTS
One hundred eight patients were analyzed. SoC VCB was delivered in 3, 4, and 5 fractions for 27 of 54 patients (50%), 11 of 54 (20%), and 16 of 54 (30%), respectively. The median total distance traveled per patient for SoC versus experimental arms was 213 versus 137 miles (p = .12), and the median cost of commute for patients was $36.3 versus $18.0 (p = .11). Compared with 2-fraction treatment, 5-fraction treatment resulted in longer travel distances (median, 462 vs 137 miles; p < .01) and increased travel costs (median, $59.3 vs $18.0; p ≤ .01). Unadjusted raw professional charges in USD per patient did not differ between SoC versus experimental arms ($9159 vs $7532; p = .19). TechCs were significantly higher in the SoC arm ($35,734 vs $24,696; p ≤ .01), as were TotCs ($44,892 vs $32,228; p < .01;). Medicare-adjusted TechCs and TotCs were higher for the SoC arm.
CONCLUSIONS
Two-fraction VCB resulted in fewer treatments per patient, reduced cost of travel compared with longer courses, and an adjusted reduction in health care expenditures compared with SoC.
目的
早期子宫内膜癌常采用子宫切除术加辅助阴道袖口近距离放疗（VCB）治疗。癌症治疗的经济毒性会影响治疗的完成。早期子宫内膜癌中标准治疗与短疗程辅助阴道袖口近距离放疗的比较（Short Course Adjuvant Vaginal Cuff Brachytherapy in Early Endometrial Cancer Compared to Standard of Care trial）是一项多中心前瞻性随机试验，比较了标准治疗（SoC）VCB 剂量的 3-5 次分割，每次分割由医生决定，与 2 次分割疗程相比。我们报告了次要成本终点，量化了较短治疗疗程对机构和参与患者的经济影响。
方法和材料
前瞻性收集技术（TechCs）、专业和总费用（TotCs），并按每位患者的原始和医疗保险调整后的费用报告。估计每位患者的治疗中心距离和邮政编码的中位数收入。使用 Mann-Whitney U 统计、t 检验和 X 检验比较两组之间的特征。
结果
分析了 108 例患者。SoC VCB 分别以 3、4 和 5 个剂量为 54 例患者中的 27 例（50%）、11 例（20%）和 16 例（30%）提供治疗。SoC 组和实验组每位患者的总旅行距离中位数分别为 213 英里和 137 英里（p=0.12），患者的通勤费用中位数分别为 36.3 美元和 18.0 美元（p=0.11）。与 2 次分割治疗相比，5 次分割治疗导致更长的旅行距离（中位数 462 英里对 137 英里；p<0.01）和更高的旅行费用（中位数 59.3 美元对 18.0 美元；p≤0.01）。SoC 组与实验组每位患者的未调整美元原始专业费用无差异（9159 美元对 7532 美元；p=0.19）。SoC 组的技术费用（TechCs）显著更高（35734 美元对 24696 美元；p≤0.01），总费用（TotCs）也更高（44892 美元对 32228 美元；p<0.01）。SoC 组的医疗保险调整后的技术费用和总费用更高。
结论
2 次分割 VCB 导致每位患者的治疗次数减少，与较长疗程相比，旅行成本降低，与 SoC 相比，医疗保健支出调整后也减少。
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