提供者收费利和癌症治疗选择:基于人口的队列研究
Aaron P Mitchell1,2, Stacie B Dusetzina3, Akriti Mishra Meza4
1Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA mitchea2@mskcc.org.
概括
瘤学家优先考虑癌症治疗的临床效益,而不是利率. 研究表明,治疗选择与患者的利益相一致,而不是提供者的利,这表明针对计费利率的政策变化不会改变使用模式.
科学领域:
- 在瘤学瘤学.
- 卫生经济学 卫生经济学
- 临床决策 临床决策
背景情况:
- 提供者对癌症治疗的收费利差异很大.
- 了解影响癌症治疗选择的因素对于患者护理和医疗保健政策至关重要.
- 国家综合癌症网络 (NCCN) 提供基于证据的治疗指南.
研究的目的:
- 调查提供者收费利与癌症治疗的临床益处之间的关联.
- 为了确定收费利是否影响瘤学家的治疗选择.
- 评估临床益处对治疗利用率的影响.
主要方法:
- 基于人口的回顾性队列研究,使用Medicare服务费索赔数据 (2015-2020年).
- 包括发生癌症的医疗保险受益者和具有不同临床益处和计费边际的治疗选择.
- 使用有条件逻辑模型与逆治疗概率权重来分析基于NCCN建议,计费率和证据块得分的治疗选择.
主要成果:
- 检查了12种癌症症状和19397名患者.
- 提供者每次治疗过程的收费利范围从0美元到12,692美元.
- 增加的计费利和治疗使用之间没有发现任何关联 (OR 0.97,95% CI 0.91-1.03).
- 较高的临床益处与增加的治疗使用显著相关 (OR 1.62,95% CI 1.15-2.29).
结论:
- 医疗保险受益人的癌症治疗选择是由临床益处驱动的,而不是提供者的收费利率.
- 影响计费利的政策或价格变化不太可能改变癌症治疗利用模式.
- 临床益处仍然是瘤学家治疗决定的主要决定因素.
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