Wang Ying, Pond Greg, Gafni Amiram Jacob, Kong Chung Yin, Ellis Peter M
Department of Oncology, BC Cancer Vancouver, University of British Columbia; Vancouver, BC V5Z 4E6, Canada.
Ontario Clinical Oncology Group, Department of Oncology, Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON L8V 1C3, Canada.
Curr Oncol. 2025 Jun 12;32(6):346. doi: 10.3390/curroncol32060346.
Previous studies have noted associations between age and healthcare costs in non-small-cell lung cancer (NSCLC). However, the drivers of cost disparities have not yet been fully examined. This retrospective cohort study included deceased patients diagnosed with stage IV NSCLC in Ontario from 1 April 2008 to 30 March 2014. Variables of interest were extracted from the Institute for Clinical Evaluative Sciences. Average monthly cancer-attributable costs (CACs), defined as the net additional costs due to cancer, determined by subtracting pre-diagnosis costs from post-diagnosis costs, were calculated by phases of care (staging, initial, continuing, and end-of-life). Regression analyses assessed predictors of cost variability. The median age of the 14,655 patients was 65 to 69 years; 54% were male and 29% had received chemotherapy. On both univariate and multivariate analysis, CACs decreased with age after cancer diagnosis across all phases of care ( < 0.001). Receiving chemotherapy contributed to higher costs in staging, initial, and continuing phases (OR 2.11, 95% C.I. 1.90-2.33, < 0.01), and lower costs in the end-of-life phase (OR 0.77, 95% C.I. 0.72-0.81, < 0.01). Our study showed that older patients had higher baseline healthcare costs and lower cancer-attributable costs following diagnosis of advanced NSCLC. Cost drivers, including treatment and gender, varied by phase of care.
既往研究已指出非小细胞肺癌（NSCLC）患者的年龄与医疗费用之间存在关联。然而，费用差异的驱动因素尚未得到充分研究。这项回顾性队列研究纳入了2008年4月1日至2014年3月30日在安大略省被诊断为IV期NSCLC的已故患者。感兴趣的变量从临床评估科学研究所提取。平均每月癌症归因成本（CACs）定义为因癌症产生的净额外成本，通过从诊断后成本中减去诊断前成本来确定，按护理阶段（分期、初始、持续和临终）计算。回归分析评估了成本变异性的预测因素。14655例患者的中位年龄为65至69岁；54%为男性，29%接受过化疗。在单变量和多变量分析中，所有护理阶段癌症诊断后的CACs均随年龄降低（<0.001）。接受化疗在分期、初始和持续阶段导致更高的成本（OR 2.11，95%CI 1.90 - 2.33，<0.01），而在临终阶段导致更低的成本（OR 0.77，95%CI 0.72 - 0.81，<0.01）。我们的研究表明，老年患者在晚期NSCLC诊断后的基线医疗费用较高，但癌症归因成本较低。包括治疗和性别在内的成本驱动因素因护理阶段而异。
