Breast Cancer Related Lymphedema: Cost of Illness and Cost Effectiveness of Alt

乳腺癌相关淋巴水肿：疾病成本和 Alt 的成本效益

基本信息

批准号：
8711070
负责人：
J. SANFORD SCHWARTZ
金额：
$ 22.67万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
资助国家：
美国
起止时间：
至
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/8711070
关键词：
Adverse event Affect African American Age Ambulatory Care Antibiotic Therapy Behavior Therapy Body Weight decreased Cancer Survivor Caucasoid Race Cellulitis Characteristics Chronic Clinical Collection Comorbidity Computerized Medical Record Control Groups Cost of Illness Data Databases Decision Modeling Development Diabetes Mellitus Economic Burden Effectiveness Exercise Failure Flare Future Health Health Care Costs Health Expenditures Hospitalization Human Infection Insurance Insurance Carriers Intervention Intervention Trial Language Life Life Style Limb structure Lymphangitis Lymphedema Medical Medical Care Costs Medical Economics Medicare Methods Modeling Morbidity - disease rate Natural History Obesity Outcome Patients Physical therapy Policies Postmenopause Preventive Productivity Public Health Publishing Peer Reviews Quality of life Recurrence Reporting Research Personnel Risk Sensitivity and Specificity Structure Survivors Swelling Symptoms T-Cell Receptor-Rearrangement Excision DNA Circles The Sun Third-Party Payer Time Training Woman arm breast cancer diagnosis cancer therapy chronic pain cohort cost cost effectiveness disability economic impact effective intervention evidence base functional status health related quality of life improved malignant breast neoplasm novel outcome forecast prevent sedentary strength training treatment as usual

项目摘要

Breast cancer related lymphedema (BCRL), characterized by arm swelling, impaired function and bothersome symptoms, is a common, persistent, often progressive adverse event of breast cancer diagnosis and therapy, exacerbated by obesity and sedentary lifestyle. The WISER Survivor Trial (Project 2) will assess in a multi-ethnic cohort of ovenweight and obese post-menopausal women witht BCRL the incremental clinicai effectiveness (lymphedema flares, cellulitis, quality of life) of exercise only, weight loss only, and exercise and weight-loss combined compared with a usual care control group. While BCRL incurs substantial health care costs (significant portions of which are borne by patients), reduces productivity and reduces quality of life, empirical data are sparse. Effective behavioral interventions such as exercise training and weight loss that temporize BCRL, mitigate its impact and prevent progression often are not reimbursed; third party payers rarely cover supplies required to mitigate BCRL. As a consequence, the current insurance structure perversely places breast cancer survivors at needless risk of BCRL adverse events and sequellae and may increase costs as a result of increased downstream complications (e.g., outpatient care and hospitalizations for repeated episodic lymphangitis and cellulitis; physical therapy for BRCL flares and symptomatic exacerbations). Thus, there is a compelling need to better characterize the medical economic impact of BCRL, as well as its short- and long-term health consequences. Project 3 will; (1) assess BCRL direct medical care costs; (2) assess the incremental cost-effectiveness of the Project 2 WISER Survivor interventions; and (3) model the impact ofthe WISER Survivor interventions over an extended time frame. The novel methodological approaches developed to define and identify BCRL cases combining and integrating data from patient reports, administrative claims and national language queries of electronic medical records will inform criteria to identify and select BCRL patients for future studies, as well as establish the validity of alternative methods, while demonstrating the feasibility and potential value of this approach for other medical conditions.

乳腺癌相关淋巴水肿 (BCRL) 的特点是手臂肿胀、功能受损和令人烦恼的症状，是乳腺癌诊断和治疗中常见的、持续的、经常进行性的不良事件，肥胖和久坐的生活方式会加剧这种不良事件。 WISER 幸存者试验（项目 2）将在多种族队列中评估患有 BCRL 的体重和肥胖绝经后妇女仅运动、减肥的增量临床效果（淋巴水肿发作、蜂窝组织炎、生活质量）与常规护理对照组相比，仅进行锻炼和减肥。虽然 BCRL 会产生大量医疗费用（其中很大一部分由患者承担）、降低生产力并降低生活质量，但经验数据却很少。有效的行为干预措施（例如运动训练和减肥）可以延缓 BCRL、减轻其影响并防止进展，但通常不会得到报销；第三方付款人很少支付缓解 BCRL 所需的供应费用。因此，当前的保险结构使乳腺癌幸存者面临不必要的风险。 BCRL 不良事件和后遗症，并可能因下游并发症增加而增加费用（例如，反复发作性淋巴管炎和蜂窝组织炎的门诊护理和住院治疗；BRCL 发作和症状加重的物理治疗）。因此，迫切需要更好地描述 BCRL 的医疗经济影响及其短期和长期健康后果。项目3将； (1) 评估 BCRL 直接医疗费用； (2) 评估项目 2 WISER Survivor 干预措施的增量成本效益； (3) 对 WISER Survivor 干预措施在较长时间内的影响进行建模。为定义和识别 BCRL 而开发的新方法结合和整合来自患者报告、行政索赔和电子病历的国家语言查询的数据的案例将为识别和选择 BCRL 患者进行未来研究的标准提供信息，并确定替代方法的有效性，同时证明以下方法的可行性和潜在价值：这种方法适用于其他医疗状况。