Lokich J J, Moore C L, Anderson N R
Cancer Center of Boston, MA 02128, USA.
Cancer. 1996 Jul 15;78(2):300-3. doi: 10.1002/(SICI)1097-0142(19960715)78:2<300::AID-CNCR17>3.0.CO;2-#.
The costs of infusion versus bolus administration of chemotherapy has been a point of controversy as has been the method of quantitating the cost. The present study analyzes the reimbursement for chemotherapy administration by infusion compared with bolus delivery based on reimbursement and relates this to cost based on projected charges and actual charges in a private practice setting.
Actual reimbursement records were retrieved for selected patients receiving infusion or bolus administration of specific chemotherapy regimens for three tumors: colon carcinoma, breast carcinoma, and lymphoma. All services were included except for radiology and hospitalization. Medicare reimbursement represented 90% of the treatment cycles analyzed.
Actual reimbursement per month for each infusion regimen was as follows: colon carcinoma, $528 (5-fluorouracil [5-FU]); breast carcinoma, $621 (doxorubicin and cyclophosphamide [AC]) and $685 (cyclophosphamide, methotrexate, and fluorouracil [CMF]); and lymphoma, $603 (cyclophosphamide, doxorubicin, vincristine, and prednisone [CHOP]). Actual reimbursement per month for a bolus regimen was colon carcinoma, $393 (5-FU + leucovorin); breast carcinoma, $991 (AC) or $453 (CMF); and lymphoma, $749 (CHOP). Actual reimbursement represents 21-36% of actual charges. Projected charges based on the model system are generally less than the actual charges.
The cost of chemotherapy as defined by reimbursement are substantially less than actual charges and are also less than projected costs based on charges. Data comparing bolus versus infusion reimbursement costs for colon carcinoma, breast carcinoma, and lymphoma indicate that differences between reimbursement for bolus and infusion administration are not substantial.
化疗的输注给药与推注给药的成本一直是一个有争议的问题，成本的量化方法也是如此。本研究基于报销情况分析了化疗输注给药与推注给药的报销情况，并将其与私人诊所环境中基于预计费用和实际费用的成本相关联。
检索了选定患者接受三种肿瘤（结肠癌、乳腺癌和淋巴瘤）特定化疗方案的输注或推注给药的实际报销记录。除放射学和住院治疗外，所有服务均包括在内。医疗保险报销占所分析治疗周期的90%。
每种输注方案每月的实际报销情况如下：结肠癌，528美元（5-氟尿嘧啶[5-FU]）；乳腺癌，621美元（阿霉素和环磷酰胺[AC]）和685美元（环磷酰胺、甲氨蝶呤和氟尿嘧啶[CMF]）；淋巴瘤，603美元（环磷酰胺、阿霉素、长春新碱和泼尼松[CHOP]）。推注方案每月的实际报销情况为：结肠癌，393美元（5-FU+亚叶酸钙）；乳腺癌，991美元（AC）或453美元（CMF）；淋巴瘤，749美元（CHOP）。实际报销占实际费用的21%-36%。基于模型系统的预计费用通常低于实际费用。
报销所定义的化疗成本远低于实际费用，也低于基于费用的预计成本。比较结肠癌、乳腺癌和淋巴瘤推注与输注报销成本的数据表明，推注给药和输注给药的报销差异不大。
