为了评估老年乳腺癌患者的辅助激素治疗依从性和持续性与医疗利用和医疗费用之间的关联，本研究利用美国肿瘤登记系统（SEER）与医疗保险索赔数据相链接的基于人口的纵向队列研究方法进行。该研究纳入了2009年至2017年被诊断为Ⅰ至Ⅲ期激素受体阳性乳腺癌的老年妇女。参与者被认为依从性高，如果他们的覆盖天数比例（PDC）大于等于0.80，并且如果他们没有中断激素治疗，即连续中断时间至少为180天。持续时间被计算为从治疗开始到中断的时间。所有参与者在激素治疗开始后的五年内被跟踪观察。根据广义线性混合模型与重复测量或如果存在过多零观测值则采用截断广义线性混合模型，评估了依从性和持续性与年度医疗利用和费用之间的关系。 本研究纳入了25,796名女性。高依从性与年度医疗利用（如住院、住院天数、急诊就诊和门诊就诊）较低有关。持续性与年度住院、住院天数、急诊就诊和门诊就诊次数较少有关。高依从性参与者的年度住院费用、门诊费用、医疗费用和总医疗费用较低，尽管处方药费用较高。无论依从与否，以及持续时间长短如何，都与年度住院费用、门诊费用、医疗费用和总医疗费用较低有关，尽管处方药费用较高。 本研究强调了依从性和持续性对辅助激素治疗的医疗利用和费用的综合措施所带来的经济效益。据我们所知，这是首个报告依从性和持续性与辅助激素治疗相关的总医疗费用节约的研究。版权所有© 2023 Elsevier Ltd. 保留所有权利。

To assess associations between adherence to and persistence with adjuvant hormone therapy, healthcare utilization, and healthcare costs among older women with breast cancer.This study was a population-based longitudinal cohort study using the Surveillance, Epidemiology, and End Results (SEER) registry linked with Medicare claims. This study included older women diagnosed with stage I-III hormone receptor-positive breast cancer from 2009 through 2017. Participants were considered adherent with a proportion of days covered (PDC) of 0.80 or more and persistent if they had no hormone therapy discontinuation, i.e., a break of at least 180 continuous days. Length of persistence was calculated as time from therapy initiation to discontinuation. All participants were followed for up to five years after hormone therapy initiation. Generalized linear mixed models with repeated measures or hurdle generalized linear mixed models in the event of excess zeroes were used to assess associations between adherence to and persistence with annual healthcare utilization and costs.This study included 25,796 women. Being adherent was associated with lower annual healthcare utilization, i.e., hospitalizations, hospital days, emergency room visits, and hospital outpatient visits. Persistence was associated with fewer annual hospitalizations, hospital days, emergency room visits, and hospital outpatient visits. Adherent participants had lower annual inpatient costs, outpatient costs, medical costs, and total healthcare costs despite higher prescription drug costs. Both being persistent and longer persistence were associated with lower inpatient costs, outpatient costs, medical costs, and total healthcare costs despite higher prescription drug costs.This study underscores the economic benefits associated with adherence to and persistence with adjuvant hormone therapy based on comprehensive measures for healthcare utilization and costs. To our best knowledge, this was the first study that reported total healthcare cost savings associated with adherence to and persistence with adjuvant hormone therapy.Copyright © 2023 Elsevier Ltd. All rights reserved.