Koopmanschap M A, van Ineveld B M, Miltenburg T E
Department of Public Health and Social Medicine, Erasmus University Rotterdam, The Netherlands.
Soc Sci Med. 1992 Oct;35(8):979-85. doi: 10.1016/0277-9536(92)90237-k.
The costs of home care in the Netherlands are estimated for women with advanced breast and cervical cancer. We observe a growing role of intensive home care for the terminally ill patients. The average costs of home care are dfl 8,500 per patient for breast cancer patients and dfl 7,200 for cervical cancer patients. More than half of these costs are incurred in the last month before death. The level of home care in the preceding months is quite modest (dfl 120 per month for both diseases), not taking into account informal care. The costs of home care for patients with advanced cancer are only slightly related to the site of the primary tumor from which the metastases originate. Total average costs per patient during advanced disease, including hospital and nursing home care, amount to dfl 42,700 for breast cancer and dfl 29,000 for cervical cancer. This difference in costs is largely attributable to the longer duration of advanced disease for breast cancer, which substantially affects hospital costs. The high costs of care to patients with advanced cancer contribute to a favourable cost-effectiveness ratio of those screening programmes which reduce mortality and consequently the costs of care to advanced cancer patients.
我们对荷兰晚期乳腺癌和宫颈癌女性患者的家庭护理成本进行了估算。我们观察到，针对绝症患者的强化家庭护理的作用日益凸显。乳腺癌患者的家庭护理平均成本为每位患者8500荷兰盾，宫颈癌患者为7200荷兰盾。其中一半以上的成本是在患者去世前的最后一个月产生的。在前几个月，家庭护理水平相当低（两种疾病每月均为120荷兰盾），未将非正式护理计算在内。晚期癌症患者的家庭护理成本与转移瘤所源自的原发肿瘤部位仅有微弱关联。晚期疾病期间每位患者的总平均成本，包括医院护理和养老院护理，乳腺癌患者为42700荷兰盾，宫颈癌患者为29000荷兰盾。成本上的这种差异很大程度上归因于乳腺癌晚期疾病持续时间更长，这对医院成本产生了重大影响。对晚期癌症患者的高额护理成本使得那些降低死亡率从而减少晚期癌症患者护理成本的筛查项目具有良好的成本效益比。
