Estimates and predictors of health care costs of esophageal adenocarcinoma: a population-based cohort study

Thein, Hla-Hla; Jembere, Nathaniel; Thavorn, Kednapa; Chan, Kelvin K. W.; Coyte, Peter C.; de Oliveira, Claire; Hur, Chin; Earle, Craig C.

doi:10.1186/s12885-018-4620-2

BMC Cancer

Table 6 Predictors of total net costs of care in individuals with a diagnosis of esophageal adenocarcinoma according to phase of care, 2003–2011: Multivariate generalized estimation equations with a log link function and gamma distribution

From: Estimates and predictors of health care costs of esophageal adenocarcinoma: a population-based cohort study

Variable	Initial Phase			Continuing Care Phase		Terminal Phase
	Estimate	95% CI	P-value	Estimate	95% CI	P-value	Estimate	95% CI	P-value
Intercept	6.012	5.588–6.461	< 0.001	4.402	3.653–5.338	< 0.001	7.718	7.176–8.288	< 0.001
Age group at index date (years)^*
< 50	Reference						Reference
50–54	− 0.021	− 0.243–0.200	0.853				−0.024	− 0.239–0.189	0.823
55–59	− 0.102	− 0.321–0.114	0.355				−0.175	− 0.385–0.033	0.099
60–64	− 0.111	− 0.317–0.092	0.289				−0.004	− 0.203–0.193	0.971
65–69	0.085	− 0.127–0.295	0.428				−0.100	− 0.302–0.100	0.331
70–74	0.064	−0.159–0.286	0.572				0.276	0.068–0.483	0.009
75–79	−0.184	− 0.409–0.041	0.109				0.125	−0.086–0.334	0.242
80–84	− 0.049	− 0.315–0.221	0.718				0.040	−0.190–0.271	0.732
≥ 85	−0.377	− 0.703– − 0.036	0.027				0.181	− 0.113–0.484	0.235
Residence
Urban	Reference
Rural	−0.159	−0.293– − 0.022	0.022
Income quintile^†
Q1 (lowest)	0.156	−0.007–0.320	0.061
Q2	−0.074	−0.239–0.091	0.378
Q3	−0.069	− 0.232–0.094	0.406
Q4	−0.112	− 0.269–0.045	0.162
Q5 (highest)	Reference
Ontario health region^**
Central							Reference
Erie St. Clair				0.107	−0.180–0.401	0.468	0.137	− 0.148–0.425	0.348
South West				−0.181	− 0.460–0.102	0.205	0.151	− 0.098–0.397	0.233
Waterloo Wellington				−0.029	− 0.326–0.277	0.851	0.356	0.089–0.623	0.009
Hamilton Niagara Haldimand Brant				0.026	−0.212–0.262	0.829	0.101	− 0.122–0.317	0.369
Central West				0.169	−0.137–0.485	0.284	−0.125	− 0.471–0.238	0.488
Mississauga				0.103	−0.216–0.433	0.534	0.213	−0.118–0.558	0.216
Toronto Central				0.122	−0.160–0.409	0.401	0.197	−0.073–0.469	0.154
Central East				0.076	−0.165–0.315	0.537	−0.080	− 0.320–0.158	0.513
South East				−0.227	− 0.491–0.039	0.093	− 0.067	− 0.319–0.182	0.598
Champlain				0.200	−0.035–0.432	0.093	0.117	−0.117–0.346	0.322
North Simcoe Muskoka				−0.047	− 0.333–0.245	0.747	0.030	− 0.250–0.314	0.833
North East				−0.103	− 0.387–0.188	0.483	0.396	0.124–0.670	0.004
North West				−0.537	− 0.899– − 0.152	0.005	0.405	0.086–0.734	0.014
ADGs^‡
0				Reference
1–3				1.619	0.659–2.408	< 0.001
4–7				1.636	0.707–2.373	< 0.001
8–10				1.712	0.788–2.442	< 0.001
11+				1.897	0.975–2.623	< 0.001
Stage at EAC diagnosis^§
Stage 0-I	Reference						Reference
Stage II	0.220	0.043–0.392	0.014				0.085	−1.167–1.938	0.911
Stage III	0.414	0.236–0.587	< 0.001				0.900	0.461–1.315	< 0.001
Stage IV	0.325	0.135–0.511	0.001				1.697	0.640–3.143	0.006
EAC treatment^¶
No treatment	Reference			Reference			Reference
Surgery alone	0.237	0.087–0.386	0.002	0.658	0.500–0.815	< 0.001	−4.123	−6.577– −0.977	0.001
Chemotherapy alone	0.190	0.012–0.371	0.038	0.420	0.223–0.620	< 0.001	−1.309	−3.154–0.547	0.150
Radiotherapy alone	0.407	0.250–0.565	< 0.001	0.513	0.334–0.693	< 0.001	−0.841	−2.750–1.280	0.387
Surgery + chemotherapy	0.423	0.185–0.671	0.001	0.590	0.362–0.824	< 0.001	−1.290	−2.019– −0.464	0.001
Surgery + radiotherapy	0.733	−0.491–2.695	0.338	−0.510	−1.375–0.653	0.312	− 0.038	− 1.564–2.854	0.970
Chemotherapy + radiotherapy	0.449	0.209–0.699	< 0.001	0.617	0.368–0.876	< 0.001	−1.292	−3.592–1.863	0.310
Surgery + chemotherapy + radiotherapy	0.942	0.243–1.810	0.017	−0.104	− 0.974–1.061	0.837	− 0.808	−2.210–1.287	0.344
Year of EAC diagnosis^€
2003	Reference			Reference			Reference
2004	0.184	− 0.212–0.555	0.346	0.012	− 0.236–0.258	0.924	−0.085	− 0.459–0.267	0.647
2005	0.357	−0.044–0.734	0.071	0.095	−0.154–0.343	0.454	0.420	0.050–0.768	0.022
2006	0.615	0.229–0.973	0.001	0.355	0.108–0.600	0.005	0.342	− 0.020–0.679	0.054
2007	0.379	−0.010–0.742	0.047	0.276	0.026–0.525	0.030	0.473	0.108–0.814	0.009
2008	0.653	0.271–1.007	0.001	0.311	0.071–0.547	0.010	0.561	0.202–0.894	0.001
2009	0.815	0.433–1.168	< 0.001	0.224	−0.015–0.460	0.064	0.660	0.303–0.991	< 0.001
2010	0.675	0.294–1.026	< 0.001	−0.099	− 0.339–0.139	0.417	0.537	0.180–0.868	0.002
2011	0.878	0.495–1.231	< 0.001	−0.458	− 0.735– − 0.178	0.001	0.531	0.169–0.869	0.003
Income quintile-Comorbidity interaction^††
Q1 (lowest)*ADGs							−0.036	− 0.184–0.112	0.629
Q2*ADGs							−0.096	− 0.165– − 0.027	0.006
Q3*ADGs							0.017	−0.041–0.077	0.563
Q4*ADGs							−0.063	−0.111– − 0.016	0.009
Comorbidity-EAC stage interaction^‡‡
ADGs 1–3*EAC stage II							1.132	−0.820–2.588	0.173
ADGs 1–3*EAC stage III							−0.446	−1.181–0.319	0.242
ADGs 1–3*EAC stage IV							−0.733	−2.219–0.399	0.256
ADGs 4–7*EAC stage II							0.274	− 1.578–1.519	0.715
ADGs 4–7*EAC stage III							−0.090	−0.482–0.304	0.652
ADGs 4–7*EAC stage IV							−0.479	−1.903–0.530	0.424
ADGs 8–10*EAC stage II							0.274	−1.569–1.500	0.712
ADGs 8–10*EAC stage III							−0.269	−0.610–0.072	0.122
ADGs 8–10*EAC stage IV							−0.821	−2.239–0.176	0.168
ADGs 11 + *EAC stage II							0.345	−1.490–1.554	0.639
ADGs 11 + *EAC stage IV							−0.535	−1.950–0.456	0.367
Comorbidity-EAC treatment interaction^‡‡‡
ADGs 1–3*Surgery alone							4.145	0.983–6.626	0.001
ADGs 1–3*Chemotherapy alone							0.885	−1.062–2.881	0.364
ADGs 1–3*Radiotherapy alone							1.126	−1.021–3.076	0.256
ADGs 1–3*Surgery + chemotherapy							−1.279	−3.018–1.679	0.238
ADGs 1–3*Chemotherapy + radiotherapy							1.926	−1.213–4.247	0.128
ADGs 4–7*Surgery alone							3.650	0.514–6.087	0.004
ADGs 4–7*Chemotherapy alone							1.304	−0.444–3.054	0.126
ADGs 4–7*Radiotherapy alone							1.135	− 0.936–2.983	0.227
ADGs 4–7*Surgery + chemotherapy							−0.003	− 0.684–0.729	0.993
ADGs 4–7*Surgery + radiotherapy							−1.133	−4.416–2.149	0.433
ADGs 4–7*Chemotherapy + radiotherapy							1.982	−1.091–4.148	0.100
ADGs 4–7*Surgery + chemotherapy + radiotherapy							0.274	−1.907–2.458	0.792
ADGs 8–10*Surgery alone							3.884	0.754–6.313	0.002
ADGs 8–10*Chemotherapy alone							1.419	−0.318–3.156	0.093
ADGs 8–10*Radiotherapy alone							0.784	−1.282–2.625	0.402
ADGs 8–10*Surgery + chemotherapy							0.319	−0.281–0.943	0.304
ADGs 8–10*Surgery + radiotherapy							0.135	−3.125–3.394	0.925
ADGs 8–10*Chemotherapy + radiotherapy							2.654	−0.410–4.800	0.027
ADGs 11 + *Surgery alone							4.185	1.060–6.604	0.001
ADGs 11 + *Chemotherapy alone							1.225	−0.499–2.950	0.143
ADGs 11 + *Radiotherapy alone							0.986	−1.076–2.823	0.291
ADGs 11 + *Chemotherapy + radiotherapy							2.253	−0.808–4.395	0.059
EAC stage-EAC treatment interaction^§§
EAC stage II*Surgery alone							0.107	−0.446–0.668	0.706
EAC stage II*Chemotherapy alone							0.031	−0.819–0.814	0.940
EAC stage II*Radiotherapy alone							−0.161	−0.814–0.476	0.622
EAC stage II*Surgery + chemotherapy							0.667	−0.294–1.576	0.158
EAC stage II*Chemotherapy + radiotherapy							−1.105	−2.191– −0.146	0.031
EAC stage III*Surgery alone							−0.182	−0.725–0.368	0.513
EAC stage III*Chemotherapy alone							−0.310	−1.158–0.470	0.452
EAC stage III*Radiotherapy alone							−0.215	− 0.861–0.415	0.506
EAC stage III*Surgery + chemotherapy							1.146	0.194–2.038	0.014
EAC stage III*Chemotherapy + radiotherapy							−0.804	−1.894–0.158	0.119
EAC stage III*Surgery + chemotherapy + radiotherapy							0.397	−1.813–2.610	0.707
EAC stage IV*Surgery alone							−0.091	−0.664–0.497	0.759
EAC stage IV*Chemotherapy alone							−0.115	−0.921–0.612	0.767
EAC stage IV*Radiotherapy alone							−0.135	− 0.757–0.471	0.666
EAC stage IV*Surgery + chemotherapy							1.315	0.326–2.272	0.008
EAC stage IV*Chemotherapy + radiotherapy							−1.162	−2.233– −0.224	0.021

CI confidence interval, ADGs Aggregated Diagnosis Groups, EAC esophageal adenocarcinoma
Initial Phase: final multivariable analysis adjusted for age group at index date, residence, income quintile, stage at EAC diagnosis. Treatment for EAC, and year of EAC diagnosis (index date). Residence and income quintile variables that were non-significant in the univariate analysis were added in the final model and became significant. Overall P values (adjusted): ^*age group at index date: P = 0.045; ^†income quintile: P = 0.009; ^§stage at EAC diagnosis: P < 0.001; ^¶treatment for EAC: P < 0.001; ^€year of EAC diagnosis: P < 0.001
Continuing Care Phase: final multivariable analysis adjusted for Ontario health region, comorbidity, measured by the Johns Hopkins ADGs, treatment for EAC, and year of EAC diagnosis (index date). Overall P values (adjusted): ^**Ontario health region: P = 0.008; ^‡comorbidity: P < 0.001; ^¶treatment for EAC: P < 0.001; ^€year of EAC diagnosis: P < 0.001
Terminal Phase: final multivariable analysis adjusted for age group at index date, Ontario health region, stage at EAC diagnosis, treatment for EAC, year of EAC diagnosis (index date), income quintile and comorbidity interaction, comorbidity and stage at EAC diagnosis interaction, comorbidity and EAC treatment interaction, and stage at EAC diagnosis and treatment for EAC interaction. Overall P values (adjusted): ^*age group at index date: P < 0.001; ^**Ontario health region: P < 0.001; ^§stage at EAC diagnosis: P < 0.001; ^¶treatment for EAC: P = 0.025; ^€year of EAC diagnosis: P < 0.001; ^††Income quintile-Comorbidity interaction: P = 0.006; ^‡‡Comorbidity-EAC stage interaction: P = 0.009; ^‡‡‡Comorbidity- EAC treatment interaction: P = 0.010; ^§§EAC stage-EAC treatment interaction: P = 0.002

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