Health Care Resource Utilization for Esophageal Cancer Using Proton versus Photon Radiation Therapy.

IF 2.1 Q3 ONCOLOGY International Journal of Particle Therapy Pub Date : 2022-06-23 eCollection Date: 2022-01-01 DOI:10.14338/IJPT-22-00001.1
Steven H Lin, Kaiping Liao, Xiudong Lei, Vivek Verma, Sherif Shaaban, Percy Lee, Aileen B Chen, Albert C Koong, Wayne L Hoftstetter, Steven J Frank, Zhongxing Liao, Ya-Chen Tina Shih, Sharon H Giordano, Grace L Smith
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引用次数: 2

Abstract

Purpose: In patients treated with chemoradiation for esophageal cancer (EC), randomized trial data demonstrate that proton beam therapy (PBT) reduces toxicities and postoperative complications (POCs) compared with intensity-modulated radiation therapy (IMRT). However, whether radiation therapy modality affects postoperative health care resource utilization remains unknown.

Materials and methods: We examined 287 patients with EC who received chemoradiation (prescribed 50.4 Gy/GyE) followed by esophagectomy, including a real-world observational cohort of 237 consecutive patients treated from 2007 to 2013 with PBT (n = 81) versus IMRT (n = 156); and an independent, contemporary comparison cohort of 50 patients from a randomized trial treated from 2012 to 2019 with PBT (n = 21) versus IMRT (n = 29). Postoperative complications were abstracted from medical records. Health care charges were obtained from institutional claims and adjusted for inflation (2021 dollars). Charge differences (Δ = $PBT - $IMRT) were compared by treatment using adjusted generalized linear models with the gamma distribution.

Results: Baseline PBT versus IMRT characteristics were not significantly different. In the observational cohort, during the neoadjuvant chemoradiation phase, health care charges were higher for PBT versus IMRT (Δ = +$71,959; 95% confidence interval [CI], $62,274-$82,138; P < .001). There was no difference in surgical charges (Δ = -$2234; 95% CI, -$6003 to $1695; P = .26). However, during postoperative hospitalization following esophagectomy, health care charges were lower for PBT versus IMRT (Δ = -$25,115; 95% CI, -$37,625 to -$9776; P = .003). In the comparison cohort, findings were analogous: Charges were higher for PBT versus IMRT during chemoradiation (Δ = +$61,818; 95% CI, $49,435-$75,069; P < .001), not different for surgery (Δ = -$4784; 95% CI, -$6439 to $3487; P = .25), and lower for PBT postoperatively (Δ = -$27,048; 95% CI, -$41,974 to -$5300; P = .02). Lower postoperative charges for PBT were especially seen among patients with any POCs in the contemporary comparison (Δ = -$176,448; 95% CI, -$209,782 to -$78,813; P = .02).

Conclusion: Higher up-front chemoradiation resource utilization for PBT in patients with EC was partially offset postoperatively, moderated by reduction in POC risks. Results extend existing clinical evidence of toxicity reduction with PBT.

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食管癌质子与光子放射治疗的保健资源利用。
目的:在接受放化疗的食管癌(EC)患者中,随机试验数据表明,与调强放疗(IMRT)相比,质子束治疗(PBT)可减少毒性和术后并发症(POCs)。然而,放射治疗方式是否影响术后医疗资源的利用仍然未知。材料和方法:我们研究了287例接受放化疗(处方50.4 Gy/GyE)后食管切除术的EC患者,包括一个现实世界的观察队列,从2007年到2013年,连续237例患者接受PBT (n = 81)和IMRT (n = 156)治疗;以及一项独立的当代比较队列,来自2012年至2019年接受PBT (n = 21)和IMRT (n = 29)治疗的随机试验的50名患者。从病历中提取术后并发症。保健费用来自机构索赔,并根据通货膨胀进行调整(2021美元)。电荷差异(Δ = $PBT - $IMRT)采用调整后的广义线性模型与伽马分布进行比较。结果:基线PBT与IMRT特征无显著差异。在观察队列中,在新辅助放化疗阶段,PBT的医疗费用高于IMRT (Δ = +$71,959;95%置信区间[CI]为62,274- 82,138美元;P < 0.001)。手术费用没有差别(Δ = - 2234美元;95%置信区间为- 6003美元至1695美元;P = .26)。然而,在食管切除术后住院期间,PBT的医疗费用低于IMRT (Δ = -$25,115;95% CI, - 37,625至- 9776美元;P = .003)。在比较队列中,结果是类似的:放化疗期间PBT的费用高于IMRT (Δ = + 61,818美元;95% ci, 49,435- 75,069美元;P < .001),手术无差异(Δ = -$4784;95% CI, - 6439至3487美元;P = .25),而术后PBT的比例更低(Δ = - 27,048美元;95% CI, - 41974至- 5300美元;P = .02)。在当代比较中,PBT的术后费用较低,特别是在任何POCs患者中(Δ = - 176,448美元;95% CI, - 209,782至- 78,813美元;P = .02)。结论:EC患者术前PBT放化疗资源利用率的提高在术后被部分抵消,并因POC风险的降低而得到缓和。结果扩展了PBT降低毒性的现有临床证据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International Journal of Particle Therapy
International Journal of Particle Therapy Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
3.70
自引率
5.90%
发文量
23
审稿时长
20 weeks
期刊最新文献
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