Bosanquet Nick, Sikora Karol
Imperial College School of Science, Medicine, and Technology, London, UK.
Lancet Oncol. 2004 Sep;5(9):568-74. doi: 10.1016/S1470-2045(04)01569-4.
Cancer care accounts for an increasing proportion of global spending on healthcare, driven by an increased incidence caused by ageing populations, greater frequency from better treatments, and changes in care that have made cancer a chronic, controllable illness. The cost of cancer care has three components: direct and easily determined clinical costs (ie, medical costs); extra financial requirement of living with disease for the patient and their family (ie, morbidity costs); and loss of income from the premature death (ie, mortality costs). Effective planning of cancer services needs detailed consideration of the economics of care delivery-an area of research that has so far been lacking outside the USA. Here, we review the literature and attempt to answer key questions on the economics of cancer care, including probable changes in disease burden over the next 20 years, changes in the way costs will be distributed between carers and delivery services, changing patterns of service delivery, and the direct contribution patients will make to treatment costs in terms of co-payments and escalating costs of comorbidity in elderly populations.
随着人口老龄化导致癌症发病率上升、更好的治疗方法使发病频率增加以及医疗护理的变化使癌症成为一种慢性、可控制的疾病，癌症护理在全球医疗保健支出中所占比例日益增加。癌症护理成本有三个组成部分：直接且易于确定的临床成本（即医疗成本）；患者及其家庭因患病而产生的额外经济需求（即发病成本）；以及过早死亡造成的收入损失（即死亡成本）。癌症服务的有效规划需要详细考虑护理服务的经济学问题——到目前为止，美国以外地区在这一研究领域一直有所欠缺。在此，我们回顾相关文献，并尝试回答有关癌症护理经济学的关键问题，包括未来20年疾病负担可能发生的变化、护理人员和服务提供方之间成本分配方式的变化、服务提供模式的改变，以及患者在共付费用和老年人群中不断攀升的合并症成本方面对治疗成本的直接贡献。
