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首页> 外文学位 >Cost and Management of Fractures in Medicare Beneficiaries with Non-Metastatic Prostate Cancer Treated with Androgen Deprivation Therapy.
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Cost and Management of Fractures in Medicare Beneficiaries with Non-Metastatic Prostate Cancer Treated with Androgen Deprivation Therapy.

机译：用雄激素剥夺疗法治疗的非转移性前列腺癌医疗保险受益人骨折的成本和管理。

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摘要

Background: Androgen deprivation therapy (ADT) in prostate cancer (PCa) is associated with increased fracture risk and costs. There is limited information regarding the use of guideline-recommended bone mineral density (BMD) testing and bisphosphonate therapy. This study examined patient-specific (e.g., comorbidity) and non-patient-specific (e.g., physician specialist visits) factors associated with BMD testing, bisphosphonate therapy, fracture risk, and costs.;Methods: This retrospective cohort analysis used linked Surveillance, Epidemiology, and End Results & Medicare data on men aged 65+ with non-metastatic PCa and treated with ADT. Cox proportional hazards models examined the association between baseline Charlson Comorbidity Index (CCI) and fracture, accounting for death as a competing risk. Partitioned weighted least squares regression models quantified the 5-year incremental cost of fractures. Multivariable logistic regression models quantified the effect of specialist visits on BMD testing and bisphosphonate use.;Results: Of 30,904 men, 6,779 (22%) had a fracture during 5-years of follow-up. Among men aged 66-74 years, the sub-hazard ratio (SHR) (95% CI) for fracture was 1.17 (1.05--1.29) for CCI=1 and 1.69 (1.51--1.90) for CCI=2+ (reference: CCI=0); CCI was not associated with fracture risk among the oldest men aged 85+ years. The mean (95% CI) incremental cost of fractures was ;Conclusions: Patients with greater comorbidity burden had increased fracture risk and higher costs associated with fractures. These patients could benefit from regular monitoring of BMD and bisphosphonate therapy, which occurred in approximately 2 in 10 men. Involving certain types of specialists (e.g., medical oncologists) in the management of men with PCa could be beneficial for bone health management.
机译：背景：前列腺癌（PCa）中的雄激素剥夺治疗（ADT）与骨折风险和费用增加相关。关于使用指南推荐的骨矿物质密度（BMD）测试和双膦酸盐治疗的信息有限。这项研究调查了与BMD测试，双膦酸盐治疗，骨折风险和费用相关的患者特异性（例如合并症）和非患者特异性（例如医师就诊）的方法。方法：本回顾性队列分析采用了相关的监测， 65岁以上非转移性PCa并接受ADT治疗的男性的流行病学，最终结果和医疗保险数据。考克斯比例风险模型检查了基线查尔森合并症指数（CCI）与骨折之间的关联，并将死亡视为竞争风险。分区加权最小二乘回归模型对骨折的5年增量成本进行了量化。多变量逻辑回归模型量化了专家就诊对BMD检测和双膦酸盐使用的影响。结果：在30,904名男性中，有6,779名（22％）在5年的随访中发生了骨折。在66-74岁的男性中，CCI = 1时骨折的亚危险比（SHR）（95％CI）为1.17（1.05--1.29），CCI = 2 +时为1.69（1.51--1.90）（参考：CCI = 0）;在85岁以上的年龄最大的男性中，CCI与骨折风险无关。结论：合并症负担较大的患者骨折风险增加，且与骨折相关的费用更高，平均（95％CI）骨折的增量成本为：结论。这些患者可以从定期监测BMD和双膦酸盐治疗中获益，大约每10名男性中就有2名发生了这种情况。让某些类型的专家（例如，肿瘤科医生）参与PCa男性的治疗可能对骨骼健康管理有益。

著录项

  • 作者

    Yong, Candice Yuk Chen.;

  • 作者单位

    University of Maryland, Baltimore.;

  • 授予单位 University of Maryland, Baltimore.;
  • 学科 Oncology.;Health care management.
  • 学位 Ph.D.
  • 年度 2015
  • 页码 161 p.
  • 总页数 161
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 地球物理学;
  • 关键词

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