Med Decis Making - Health care costs for state transition models in prostate cancer.

Tópicos

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Resumo

JECTIVE: To obtain estimates of direct health care costs for prostate cancer (PC) from diagnosis to death to inform state transition models.METHODS: A stratified random sample of PC patients residing in 3 geographically diverse regions of Ontario, Canada, and diagnosed in 1993-1994, 1997-1998, and 2001-2002, was selected from the Ontario Cancer Registry. We retrieved patients' pathology reports to identify referring physicians and contacted surviving patients and next of kin of deceased patients for informed consent. We reviewed clinic charts to obtain data required to allocate each patient's observation time to 11 PC-specific health states. We linked these data to health care administrative databases to calculate resource use and costs (Canadian dollars, 2008) per health state. A multivariable mixed-effects model determined predictors of costs.RESULTS: The final sample numbered 829 patients. In the regression model, total direct costs increased with age, comorbidity, and Gleason score (all P < 0.0001). Radical prostatectomy was the most costly primary treatment health state ($4676 per 100 days). Radical prostatectomy, hormone-refractory metastatic disease ($6398 per 100 days), and final (predeath) ($13,739 per 100 days) health states were significantly more costly (P < 0.05) than nontreated nonmetastatic PC ($3440 per 100 days), whereas the postprostatectomy ($732 per 100 days) and postradiation ($1556 per 100 days) states cost significantly less (P < 0.0001).CONCLUSIONS: This study used an innovative but labor-intensive approach linking chart and administrative data to estimate health care costs. Researchers should weigh the potential benefits of this method against what is involved in implementation. Modifications in methodology may achieve similar gains with less outlay in individual studies. However, we believe that this is a promising approach for researchers wishing to advance the quality of costing in state transition modeling.

Resumo Limpo

jectiv obtain estim direct health care cost prostat cancer pc diagnosi death inform state transit modelsmethod stratifi random sampl pc patient resid geograph divers region ontario canada diagnos select ontario cancer registri retriev patient patholog report identifi refer physician contact surviv patient next kin deceas patient inform consent review clinic chart obtain data requir alloc patient observ time pcspecif health state link data health care administr databas calcul resourc use cost canadian dollar per health state multivari mixedeffect model determin predictor costsresult final sampl number patient regress model total direct cost increas age comorbid gleason score p radic prostatectomi cost primari treatment health state per day radic prostatectomi hormonerefractori metastat diseas per day final predeath per day health state signific cost p nontreat nonmetastat pc per day wherea postprostatectomi per day postradi per day state cost signific less p conclus studi use innov laborintens approach link chart administr data estim health care cost research weigh potenti benefit method involv implement modif methodolog may achiev similar gain less outlay individu studi howev believ promis approach research wish advanc qualiti cost state transit model

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