背景:乳腺癌(BC)治疗随着新的和昂贵的疗法而迅速发展。现有的成本计算模型捕获当前治疗成本的能力有限。我们使用基于活动的成本计算(ABC)方法来确定按分期和分子亚型进行BC治疗的每例成本。
方法:ABC用于按比例整合基于多学科证据的患者和提供者治疗方案,按阶段和分子亚型计算治疗总持续时间的个案成本。诊断成像,病理学,手术,放射治疗,全身治疗,住院,紧急情况,包括家庭护理和姑息治疗费用。
结果:BC的治疗费用高于以前的研究,并且因分子亚型而异。费用随疾病阶段呈指数增长。DCIS的每例治疗费用(2023C$)为14,505加元,所有亚型的平均费用为39,263加元,76,446加元,97,668加元和370,398加元,II,公元前III年和IV年,分别。第四阶段的费用高达每例516,415加元。当按人群中分子亚型的比例加权时,第一阶段的案件费用为31,749加元,66,758加元,111,368加元和289,598加元,II,公元前III年和IV年,分别。与第一阶段相比,第四阶段的成本差异幅度高达10.9倍,第III阶段与第I阶段相比为4.4倍,第IV阶段与DCIS相比为35.6倍。
结论:随着新疗法和生存率的提高,BC治疗的成本正在迅速上升,导致后期疾病的治疗费用呈指数增长。我们提供实时,以病例为基础的BC治疗成本计算,可以评估卫生系统的经济影响,并准确了解筛查的成本效益。
Breast cancer (BC) treatment is rapidly evolving with new and costly therapeutics. Existing costing models have a limited ability to capture current treatment costs. We used an Activity-Based Costing (ABC) method to determine a per-case cost for BC treatment by stage and molecular subtype.
ABC was used to proportionally integrate multidisciplinary evidence-based patient and provider treatment options for BC, yielding a per-case cost for the total duration of treatment by stage and molecular subtype. Diagnostic imaging, pathology, surgery, radiation therapy, systemic therapy, inpatient, emergency, home care and palliative care costs were included.
BC treatment costs were higher than noted in previous studies and varied widely by molecular subtype. Cost increased exponentially with the stage of disease. The per-case cost for treatment (2023C$) for DCIS was C$ 14,505, and the mean costs for all subtypes were C$ 39,263, C$ 76,446, C$ 97,668 and C$ 370,398 for stage I, II, III and IV BC, respectively. Stage IV costs were as high as C$ 516,415 per case. When weighted by the proportion of molecular subtype in the population, case costs were C$ 31,749, C$ 66,758, C$ 111,368 and C$ 289,598 for stage I, II, III and IV BC, respectively. The magnitude of cost differential was up to 10.9 times for stage IV compared to stage I, 4.4 times for stage III compared to stage I and 35.6 times for stage IV compared to DCIS.
The cost of BC treatment is rapidly escalating with novel therapies and increasing survival, resulting in an exponential increase in treatment costs for later-stage disease. We provide real-time, case-based costing for BC treatment which will allow for the assessment of health system economic impacts and an accurate understanding of the cost-effectiveness of screening.