Abramowitz L, Rémy V, Vainchtock A
Proctology Unit, Bichat Hospital, 75018 Paris, France.
Rev Epidemiol Sante Publique. 2010 Oct;58(5):331-8. doi: 10.1016/j.respe.2010.06.165.
The incidence of anal cancer has increased over the last 25 years. No organized screening exists for the precursors of anal cancer (anal intraepithelial neoplasia and carcinoma in situ) and diagnosis is often delayed. Treatment for precursor lesions is of limited success, while cancer management is traumatic for the patient. Like cancers of the cervix, most cases of anal cancer are associated with infection with human papillomavirus (HPV). With increases in the incidence of anal cancer, and in light of the availability of prevention strategies such as screening and HPV vaccination, it is important, from a public health perspective, to assess the economic burden of anal cancer in France.
We performed a retrospective analysis based on data extracted from a French hospital database - the Programme de médicalisation des systèmes d'information (PMSI) - to assess the number and management of patients hospitalized for anal cancer in 2006. Data on radiotherapy sessions performed in private hospitals were obtained from the Statistiques annuelles des établissements de santé (SAE) database. Costs of hospitalization, from the healthcare-payer perspective, were obtained from official diagnosis-related group tariffs for public and private hospitals. Ambulatory and indirect costs were estimated using information obtained from the literature.
In 2006, 3,711 patients with anal cancer were treated in hospitals in France. Of these, the majority were women (69%). The annual cost of hospital treatment for anal cancer was estimated at € 20,326,868. The overall estimated cost (including hospitalization, outpatient and daily allowances costs) to the healthcare payer was € 38,249,981.
This study, the first to investigate the economic burden of anal cancer in France, shows that the management costs of anal cancer are high and comparable to cervical cancer management costs (€ 44 million). Further research is required to determine the cost of management of precursor lesions, which is mostly performed in an outpatient setting. Prophylactic HPV vaccination could significantly reduce the burden of this disease.
在过去25年中，肛门癌的发病率有所上升。目前尚无针对肛门癌前体（肛门上皮内瘤变和原位癌）的有组织筛查，诊断往往延迟。前体病变的治疗成功率有限，而癌症治疗对患者来说具有创伤性。与宫颈癌一样，大多数肛门癌病例与人乳头瘤病毒（HPV）感染有关。鉴于肛门癌发病率上升，且有筛查和HPV疫苗接种等预防策略，从公共卫生角度评估法国肛门癌的经济负担很重要。
我们基于从法国医院数据库——信息系统医疗化计划（PMSI）——提取的数据进行了一项回顾性分析，以评估2006年因肛门癌住院患者的数量和治疗情况。私立医院进行的放疗疗程数据来自健康机构年度统计（SAE）数据库。从医疗支付方角度来看，住院费用来自公立和私立医院的官方诊断相关组费率。门诊和间接费用使用从文献中获得的信息进行估算。
2006年，法国医院共治疗了3711例肛门癌患者。其中，大多数为女性（69%）。肛门癌住院治疗的年度费用估计为20326868欧元。医疗支付方的总体估计费用（包括住院、门诊和每日津贴费用）为38249981欧元。
这项首次调查法国肛门癌经济负担的研究表明，肛门癌的管理成本很高，与宫颈癌管理成本（4400万欧元）相当。需要进一步研究以确定主要在门诊进行的前体病变管理成本。预防性HPV疫苗接种可显著减轻这种疾病的负担。
