垂直整合和瘤学家在非小细胞肺癌中采用免疫检查点抑制剂
Xin Hu1, Changchuan Jiang2, K Robin Yabroff3
1Department of Radiation Oncology, Emory University School of Medicine, and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.
Health services research
|February 19, 2025
概括
免疫检查点抑制剂 (ICI) 在转移性非小细胞肺癌 (NSCLC) 中的使用在FDA批准后显著增加. 瘤学家的垂直整合没有影响长期ICI使用,尽管最初采用速度更快.
科学领域:
- 在瘤学瘤学.
- 医疗保健服务研究 医疗服务研究
- 癌症治疗方法 癌症治疗方法
背景情况:
- 免疫检查点抑制剂 (ICI) 代表了转移性非小细胞肺癌 (NSCLC) 治疗的重大进展.
- 癌症护理的环境正在不断变化,癌症实践在卫生系统内越来越多地垂直整合.
- 了解影响ICI等新疗法的采用和传播的因素对于公平的患者获取至关重要.
研究的目的:
- 分析ICI在转移性NSCLC患者在2015年FDA批准之前和之后使用ICI的趋势.
- 调查瘤学家的垂直整合与ICI的采用模式之间的联系.
- 评估瘤学家的整合状态是否会随着时间的推移影响ICI的使用.
主要方法:
- 使用SEER-Medicare数据 (2010-2019) 进行的回顾性队列研究,针对65.5岁以上的转移性NSCLC患者.
- 癌症专家的垂直整合定义为≥10%的服务通过医院门诊部门收费.
- 使用差异差异 (DID) 建模来比较ICI使用概率与非集成瘤学家相比.
主要成果:
- 整体ICI使用率从2015年之前的0%增加到2015年的4.0%,到2019年增加到29.2%.
- 2015年,综合瘤学家的ICI使用率较高 (6.9%),而非综合瘤学家的使用率为2.0%,但到2017年,采用率趋同 (19.8%对比19.8%).
- DID分析显示,与瘤学家整合相关的ICI使用概率没有显著变化 (1.7个百分点,95%CI:-1.0至4.4).
结论:
- 综合瘤学家最初在FDA批准后更快地采用ICI,但随着时间的推移,这一领先地位逐渐下降.
- 垂直整合到卫生系统与ICI利用的变化没有显著关联.
- 需要进行进一步的研究,以确定促进在不同实践环境中获得新型癌症治疗的公平准入的因素.
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