Taplin S H, Barlow W, Urban N, Mandelson M T, Timlin D J, Ichikawa L, Nefcy P
Group Health Cooperative, Seattle, Wash. 98101-1448.
J Natl Cancer Inst. 1995 Mar 15;87(6):417-26. doi: 10.1093/jnci/87.6.417.
This study was conducted to evaluate the effect of stage at diagnosis, age, and level of comorbidity (presence of other illness) on the costs of treating three types of cancer among members of a health maintenance organization.
Among 388,000 members enrolled anytime during 1990 and 1991 in Group Health Cooperative (GHC) of Puget Sound (Washington State), we estimated the total and net direct costs of medical care for colon, prostate, and breast cancers, including both incident (290, 554, and 645 patients, respectively) and prevalent (1046, 1295, and 2299 patients, respectively) cases. We summarized costs for initial, continuing, and terminal phases of care. Net costs were the difference between the costs of the care of each case subject and the average costs of the care for all enrollees without the cancer of interest who were of the same sex and in the same 5-year age group. Differences in estimated total and net costs by stage at diagnosis, age, and comorbidity were separately evaluated using multivariate regression modeling. All P values were two-sided. Comorbidity was based on a score calculated from 1988 pharmacy data.
Total costs of initial care increased with stage at diagnosis for colon (P = .0013) and breast (P < .0001) cancer cases, but not for prostate cancer cases. Total initial costs decreased with age for prostate (P = .0225) and breast (P = .0002) cancers but did not change with degree of comorbidity for any of the three cancers. Total continuing medical care costs increased with stage at diagnosis for colon (P < .0001) and breast (P < .0001) cancer cases but not for prostate cancer cases. Total terminal care costs were similar by stage for all three cancers. Net initial costs differed with stage for all three cancers (P < .05). Net continuing care costs increased with stage (P < .0001) and decreased with age (P < .001) for colon and breast cancers but not for prostate cancer. Net continuing care costs decreased with comorbidity for all three cancers (P = .004, P = .011, and P < .0001 for colon, prostate, and breast cancers, respectively). Among regional stage cancers, continuing care costs decreased with age for colon (P < .0017) and breast (P = .033) cancers but not for prostate cancers.
The results show that total costs vary by stage at diagnosis and age, but the patterns of variation differ for each cancer. Costs of cancer are not simply additive to costs of other conditions.
More needs to be done to explore the reasons and implications of age-related cost differences. Cost-effectiveness analyses of cancer control interventions that shift cancer stage distributions may need to consider both the age and comorbidity of the target populations.
本研究旨在评估诊断分期、年龄和合并症水平（其他疾病的存在情况）对健康维护组织成员中三种癌症治疗费用的影响。
在1990年至1991年期间任何时间加入普吉特海湾地区（华盛顿州）健康合作组织（GHC）的388,000名成员中，我们估算了结肠癌、前列腺癌和乳腺癌的医疗总直接费用和净直接费用，包括新发病例（分别为290例、554例和645例患者）和现患病例（分别为1046例、1295例和2299例患者）。我们总结了护理初始阶段、持续阶段和终末期阶段的费用。净费用是每个病例对象的护理费用与所有未患所关注癌症的同性且处于相同5岁年龄组的参保者平均护理费用之间的差值。使用多变量回归模型分别评估诊断分期、年龄和合并症对估计的总费用和净费用的差异。所有P值均为双侧。合并症基于从1988年药房数据计算得出的分数。
结肠癌（P = 0.0013）和乳腺癌（P < 0.0001）病例的初始护理总费用随诊断分期增加，但前列腺癌病例并非如此。前列腺癌（P = 0.0225）和乳腺癌（P = 0.0002）的初始总费用随年龄降低，但三种癌症中的任何一种的总费用均不随合并症程度变化。结肠癌（P < 0.0001）和乳腺癌（P < 0.0001）病例的持续医疗护理总费用随诊断分期增加，但前列腺癌病例并非如此。所有三种癌症的终末期护理总费用在各分期相似。所有三种癌症的净初始费用因分期而异（P < 0.05）。结肠癌和乳腺癌的净持续护理费用随分期增加（P < 0.0001）且随年龄降低（P < 0.001），但前列腺癌并非如此。所有三种癌症的净持续护理费用随合并症程度降低（结肠癌、前列腺癌和乳腺癌的P值分别为0.004、0.011和P < \alpha{"name":"GodelPlugin","parameters":{"input":"0.0001"}})α0.0001）。在区域分期癌症中，结肠癌（P < 0.0017）和乳腺癌（P = 0.033）的持续护理费用随年龄降低，但前列腺癌并非如此。
结果表明，总费用因诊断分期和年龄而异，但每种癌症的变化模式不同。癌症费用并非简单地叠加在其他疾病的费用之上。
需要做更多工作来探索与年龄相关的费用差异的原因和影响。改变癌症分期分布的癌症控制干预措施的成本效益分析可能需要考虑目标人群的年龄和合并症情况。
