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Surgical Management of Breast Cancer: Patterns, Trends, and Economic Burden of Women in a Privately Insured Population in Texas

机译：乳腺癌的外科手术管理：德克萨斯州有私人参保人口的妇女的模式，趋势和经济负担

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摘要

Objective: The overall objective of this study is to understand the patient, provider, and area-level factors associated with utilization patterns of surgery for unilateral breast cancer. Furthermore, the study examines the geographic variation in and medical costs associated with surgical treatment for breast cancer among women with unilateral breast cancer in a privately insured population in Texas. Method: We used a retrospective population-based cohort study design with enrollment and administrative claims data for women ages 18 years and older, insured by Blue Cross Blue Shield of Texas from 2008 to 2013. The study cohort consisted of women with a unilateral breast cancer diagnosis and a claim for breast surgery (breast conserving surgery (BCS) or mastectomy). Clinical and economic outcomes included: (1) type of breast surgery received and (2) one-year total medical and reconstruction-related costs; the main predictor variable was the receipt of genetic testing for genetic susceptibility to breast cancer. Generalized linear mixed models were used to determine the factors associated with the type of breast surgery received. Generalized linear models were used to predict the one-year costs of surgical treatment with and without reconstructive surgery. Results: A total of 1,771 women were included in the study cohort (927 = BCS, 844 = mastectomy). 42.4% of women had a claim for genetic testing and 32.7% of women had a reconstructive procedure within one year following index breast surgery. Patient-level factors were found to be significantly associated with surgical treatment for breast cancer. Receipt of genetic testing, as well as patient comorbidity had a significant impact, such that sicker patients were more likely to have received BCS rather than mastectomy. Provider and area-level characteristics were not significant predictors of the type of surgery received. Rates per 100,000 for both surgery groups decreased across the study period, with the exception of an unexplained spike in 2009. Significant geographic variation was found to exist across the state. A much higher percentage of women in the mastectomy group had a reconstructive procedure (90% vs 10%, p<0.0001). Results from the generalized linear model showed that patients who received BCS had significantly lower adjusted total medical costs ($173,372 vs $232,582, p<0.001), lower adjusted reconstruction-related costs ($39,392 vs $89,590, p<0.001), and lower inpatient costs ($99,907 vs $139,832, p<0.001). Conclusions: This study shows the significant impact of genetic testing on the type of breast cancer surgery received following the first national recommendations on the issue. As hypothesized, women who did not have genetic testing for breast cancer were less likely to undergo mastectomy.
机译：目的：本研究的总体目标是了解与单侧乳腺癌手术利用模式相关的患者，提供者和地区层面的因素。此外，该研究还检查了得克萨斯州一个私人保险人群中单侧乳腺癌妇女的乳腺癌手术治疗的地域差异和医疗费用。方法：我们采用回顾性的人群队列研究设计，纳入了18岁以上女性的入学和行政申索数据，由得克萨斯州的Blue Cross Blue Shield于2008年至2013年为其提供保险。该研究队列由患有单侧乳腺癌的妇女组成诊断并要求进行乳房手术（保乳手术（BCS）或乳房切除术）。临床和经济成果包括：（1）接受的乳房手术类型和（2）一年的医疗和重建相关总费用；主要的预测变量是接受基因测试以了解乳腺癌的遗传易感性。使用广义线性混合模型来确定与所接受的乳房手术类型相关的因素。使用广义线性模型来预测有无重建手术的一年手术治疗费用。结果：总共1,771名女性被纳入研究队列（927 = BCS，844 =乳房切除术）。 42.4％的女性要求进行基因检测，而32.7％的女性在进行指数乳腺手术后一年内进行了重建手术。发现患者水平的因素与乳腺癌的手术治疗显着相关。接受基因检测以及患者合并症具有重大影响，因此，病情较重的患者更有可能接受BCS而非乳房切除术。提供者和地区水平特征不是所接受手术类型的重要预测指标。在整个研究期间，两个外科手术组的每100,000例发病率均下降，除了2009年的原因不明的高峰。发现整个州都存在明显的地理差异。乳房切除术组中有较高百分比的妇女接受了重建手术（90％比10％，p <0.0001）。广义线性模型的结果表明，接受BCS的患者调整后的总医疗费用（173,372美元对232,582美元，p <0.001）显着降低，与重建相关的调整后成本（39,392对89,590美元，p <0.001）显着降低，住院费用也较低（ 99,907美元对139,832美元，p <0.001）。结论：这项研究表明，在有关该问题的第一项国家建议之后，基因检测对所接受的乳腺癌手术类型具有重大影响。如所假设的，未进行乳腺癌基因检测的女性较少接受乳房切除术。

著录项

  • 作者

    Prasad, Sapna A.;

  • 作者单位

    The University of Texas School of Public Health.;

  • 授予单位 The University of Texas School of Public Health.;
  • 学科 Public health.
  • 学位 Ph.D.
  • 年度 2017
  • 页码 89 p.
  • 总页数 89
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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