Huang Hui-Yao, Shi Ju-Fang, Guo Lan-Wei, Bai Ya-Na, Liao Xian-Zhen, Liu Guo-Xiang, Mao A-Yan, Ren Jian-Song, Sun Xiao-Jie, Zhu Xin-Yu, Wang Le, Song Bing-Bing, Du Ling-Bin, Zhu Lin, Gong Ji-Yong, Zhou Qi, Liu Yu-Qin, Cao Rong, Mai Ling, Lan Li, Sun Xiao-Hua, Ren Ying, Zhou Jin-Yi, Wang Yuan-Zheng, Qi Xiao, Lou Pei-An, Shi Dian, Li Ni, Zhang Kai, He Jie, Dai Min
Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing, 100021, P. R. China.
Department of Cancer Epidemiology, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, P. R. China.
Chin J Cancer. 2017 Apr 28;36(1):41. doi: 10.1186/s40880-017-0209-4.
The increasing prevalence of colorectal cancer (CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.
We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan (CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup (hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure.
A total of 2356 patients with a mean age of 57.4 years were included, 57.1% of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY. The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage I, II, III, and IV disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3% of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups (P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more, whereas those with a lower household income and those who underwent surgery spent less (all P < 0.05).
For patients in China, direct expenditure for the diagnosis and treatment of CRC seemed catastrophic, and non-medical expenditure was non-ignorable. The financial burden varied among subgroups, especially among patients with different clinical stages of disease, which suggests that, in China, CRC screening might be cost-effective.
中国结直肠癌（CRC）的发病率日益上升，而相关费用信息匮乏，这凸显了更好地了解CRC诊断和治疗的经济负担及影响的必要性。我们开展了一项调查，以量化中国CRC患者的直接医疗和非医疗费用以及由此产生的经济负担。
2012年至2014年期间，我们在中国13个省份的37家三级医院进行了一项多中心横断面调查。使用结构化问卷对每位入选患者进行访谈。所有费用数据均按2014年人民币（CNY；1元人民币 = 0.163美元）进行了通胀调整。我们按亚组（医院类型、诊断时年龄、性别、教育程度、职业、保险类型、家庭收入、临床分期、病理类型和治疗方案）对总费用和经济负担进行了量化。然后进行广义线性建模，以确定与总费用相关的因素。
共纳入2356例患者，平均年龄57.4岁，其中57.1%为男性；13.9%的患者为I期癌症；前一年家庭平均收入为54,525元人民币。估计每位患者的总体平均直接费用为67,408元人民币，I期、II期、III期和IV期疾病的费用分别为56,099元人民币、59,952元人民币、67,292元人民币和82,729元人民币。非医疗费用占总费用的8.3%。新诊断患者的1年自付费用为32,649元人民币，占其前一年家庭收入的59.9%，导致75.
