姑息治疗对晚期癌症患者药物使用和医疗资源利用的影响

doi:10.19723/j.issn.1671-167X.2025.05.027

摘要/Abstract

摘要： 目的: 评价姑息治疗对晚期癌症患者药物使用、医疗服务利用及医疗费用的影响。方法: 基于2018—2020年北京大学肿瘤医院患者就诊记录，采用广义精确匹配法构建包括姑息治疗与常规治疗两组患者队列，分别选取阿片类镇痛药物月均使用量、住院率、重症监护室(intensive care unit，ICU)率、手术率、月均总费用等指标评价药物使用、医疗服务利用与医疗费用，采用卡方检验和Wilcoxon符号秩检验比较暴露前后两组患者结局指标差异及姑息治疗组患者结局指标变化，采用倍差法测算姑息治疗对患者各结局指标的净影响值。结果: 最终纳入180例姑息治疗组患者与3 101例常规治疗组患者，组间匹配效果良好(L₁ < 0.1)。暴露前后，姑息治疗组阿片类药物月均使用量均显著高于常规治疗组(暴露前：0.3 DDD/人月vs. 0.1 DDD/人月，P < 0.01；暴露后：0.7 DDD/人月vs. 0.1 DDD/人月，P < 0.01；DDD为限定日剂量，defined daily dose)，姑息治疗显著增加了患者的阿片类药物月均使用量(增加0.3 DDD/人月，P < 0.01)。暴露后，姑息治疗组住院率和手术率均显著低于常规治疗组(48.9% vs. 74.3%，3.9% vs. 8.8%，P均 < 0.01)，两组患者的ICU率相似(1.1% vs. 1.6%，P=0.634)。姑息治疗显著降低了患者的住院率、ICU率和手术率，分别降低25.6%、4.9%和14.5%(P均 < 0.01)。暴露前后，姑息治疗组月均总费用均略高于常规治疗组(暴露前：20 092.3元vs. 19 132.8元，P=0.725；暴露后：9 719.8元vs. 8 818.8元，P=0.165)，但姑息治疗对患者的月均总费用无显著影响(增加2 208.8元，P=0.316)。结论: 姑息治疗可以增加晚期癌症患者阿片类药物使用量，降低住院率、ICU率和手术率，而对患者医疗费用无显著影响。

关键词: 姑息疗法, 肿瘤, 阿片, 药物利用, 医疗服务利用, 医疗费用

Abstract: Objective: To evaluate the effect of palliative care on drug use, medical service utilization and medical expenditure of patients with advanced cancer. Methods: A cohort of patients including pal-liative care and standard care was constructed using the medical records of the patients in Peking University Cancer Hospital from 2018 to 2020, and coarsened exact matching was used to match the two groups of patients. The average monthly opioid consumption, hospitalization rate, intensive care unit (ICU) rate and operation rate, and the average monthly total cost were selected to evaluate drug use, medical service utilization and medical expenditure. Chi-square test and Wilcoxon signed rank test were used to compare the differences between the two groups before and after exposure and the change in the palliative care group. The net impact of palliative care on the patients was calculated using the difference-in-differences analysis. Results: In this study, 180 patients in the palliative care group and 3 101 patients in the stan-dard care group were finally included in the matching, and the matching effect of the two groups was good (L₁ < 0.1). Before and after exposure, the average monthly opioid consumption in the palliative care group was significantly higher than that in the standard care group (Before exposure: 0.3 DDD/person-month vs. 0.1 DDD/person-month, P < 0.01; After exposure: 0.7 DDD/person-month vs. 0.1 DDD/person-month, P < 0.01; DDD refers to defined daily dose), palliative care significantly increased the average monthly opioid consumption in the patients (0.3 DDD/person-month, P < 0.01). The hospitalization rate (48.9% vs. 74.3%, P < 0.01) and operation rate (3.9% vs. 8.8%, P < 0.01) of the patients in palliative care group were significantly lower than those in standard care group, and the ICU rate became similar between the two groups (1.1% vs. 1.6%, P=0.634). Palliative care significantly reduced the patients ' hospitalization rate (-25.6%, P < 0.01), ICU rate (-4.9%, P < 0.01) and operation rate (-14.5%, P < 0.01). Before and after exposure, the average monthly total costs of pal-liative care group were slightly higher than those of standard care group (Before exposure: 20 092.3 yuan vs. 19 132.8 yuan, P=0.725; After exposure: 9 719.8 yuan vs. 8 818.8 yuan, P=0.165). Palliative care increased the average monthly total cost by 2 208.8 yuan, but it was not statistically significant (P=0.316). Conclusion: Palliative care can increase the opioid consumption in advanced cancer patients, reduce the rates of hospitalization, ICU and surgery, but has no significant effect on medical expenditure.

Key words: Palliative care, Neoplasm, Opium, Drug utilization, Medical service utilization, Medical expenditure

中图分类号:

R730.5

陈定一, 杜浩鑫, 张逸晨, 王闫飞, 刘巍, 焦园园, 史录文, 管晓东, 卢新璞. 姑息治疗对晚期癌症患者药物使用和医疗资源利用的影响[J]. 北京大学学报（医学版）, 2025, 57(5): 996-1001.

Dingyi CHEN, Haoxin DU, Yichen ZHANG, Yanfei WANG, Wei LIU, Yuanyuan JIAO, Luwen SHI, Xiaodong GUAN, Xinpu LU. Impact of palliative care on medication use and medical utilization in patients with advanced cancer[J]. Journal of Peking University (Health Sciences), 2025, 57(5): 996-1001.

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Items	Palliative care group (n=180)	Standard care group (n=3 101)	L₁
Sex			＜0.01
Female	55 (30.6)	1 198 (38.6)
Male	125 (69.4)	1 903 (61.4)
Age/years			0.013
18-44	8 (4.4)	54 (1.7)
45-64	75 (41.8)	1 308 (42.2)
≥65	97 (53.9)	1 739 (56.1)
Location of medical insurance			0.046
Local	42 (23.3)	578 (18.6)
Non-local	138 (76.7)	2 523 (81.4)
Year of diagnosis			0.072
2011-2015	13 (7.2)	30 (1.0)
2016-2020	167 (92.8)	3 071 (99.0)
Cancer site			0.044
Digestive system	80 (44.4)	984 (31.7)
Respiratory system	19 (10.6)	242 (7.8)
Genital system	1 (0.6)	3 (0.1)
Hematologic system	1 (0.6)	259 (8.4)
Breast	5 (2.8)	13 (0.4)
Head and neck	6 (3.3)	7 (0.2)
Other sites	6 (3.3)	9 (0.3)
Not specified	62 (34.4)	1 584 (51.1)

Outcomes	Before exposure			After exposure
Outcomes	Palliative care group	Standard care group	P	Palliative care group	Standard care group	P
Drug use
Average monthly opioid consumption/DDD per person-month	0.3	0.1	＜0.01	0.7^*	0.1	＜0.01
Medical service utilization
Hospital rate/%	100.0	99.8	0.555	48.9^*	74.3	＜0.01
ICU rate/%	6.7	2.3	＜0.01	1.1^*	1.6	0.634
Operation rate/%	25.6	15.1	＜0.01	3.9^*	8.8	＜0.01
Medical expenditure
Average monthly total cost/yuan	20 092.3	19 132.8	0.725	9 719.8	8 818.8	0.165

Outcomes	Net effect value	\|t\|	P
Drug use
Average monthly opioid consumption/DDD per person-month	0.3	4.48	＜0.01
Medical service utilization
Hospital rate/%	-25.6	4.53	＜0.01
ICU rate/%	-4.9	3.17	＜0.01
Operation rate/%	-14.5	4.02	＜0.01
Medical expenditure
Average monthly total cost/yuan	2 208.8	1.00	0.316