中美洲萨尔瓦多儿童癌症治疗的成本和成本效益：来自儿童癌症 2030 网络的报告。
The cost and cost-effectiveness of childhood cancer treatment in El Salvador, Central America: A report from the Childhood Cancer 2030 Network.
机构信息
Department of Oncology, Benjamin Bloom Hospital, San Salvador, El Salvador.
Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee.
出版信息
Cancer. 2018 Jan 15;124(2):391-397. doi: 10.1002/cncr.31022. Epub 2017 Sep 15.
BACKGROUND
Although previous studies have examined the cost of treating individual childhood cancers in low-income and middle-income countries, to the authors' knowledge none has examined the overall cost and cost-effectiveness of operating a childhood cancer treatment center. Herein, the authors examined the cost and sources of financing of a pediatric cancer unit in Hospital Nacional de Ninos Benjamin Bloom in El Salvador, and make estimates of cost-effectiveness.
METHODS
Administrative data regarding costs and volumes of inputs were obtained for 2016 for the pediatric cancer unit. Similar cost and volume data were obtained for shared medical services provided centrally (eg, blood bank). Costs of central nonmedical support services (eg, utilities) were obtained from hospital data and attributed by inpatient share. Administrative data also were used for sources of financing. Cost-effectiveness was estimated based on the number of new patients diagnosed annually and survival rates.
RESULTS
The pediatric cancer unit cost $5.2 million to operate in 2016 (treating 90 outpatients per day and experiencing 1385 inpatient stays per year). Approximately three-quarters of the cost (74.7%) was attributed to 4 items: personnel (21.6%), pathological diagnosis (11.5%), pharmacy (chemotherapy, supportive care medications, and nutrition; 31.8%), and blood products (9.8%). Funding sources included government (52.5%), charitable foundations (44.2%), and a social security contribution scheme (3.4%). Based on 181 new patients per year and a 5-year survival rate of 48.5%, the cost per disability-adjusted life-year averted was $1624, which is under the threshold considered to be very cost effective.
CONCLUSIONS
Treating childhood cancer in a specialized unit in low-income and middle-income countries can be done cost-effectively. Strong support from charitable foundations aids with affordability. Cancer 2018;124:391-7. © 2017 American Cancer Society.
背景
尽管先前的研究已经考察了在低收入和中等收入国家治疗个别儿童癌症的成本，但据作者所知，尚无研究考察运营儿童癌症治疗中心的总体成本和成本效益。在此，作者检查了萨尔瓦多本杰明·布鲁姆国家儿童医院儿科癌症病房的成本和资金来源，并对成本效益进行了估计。
方法
为儿科癌症病房获取了 2016 年有关成本和投入量的管理数据。为中央提供的共享医疗服务（例如血库）获取了类似的成本和量数据。从中获取中央非医疗支持服务（例如水电费）的成本，并按住院患者份额分配。管理数据还用于确定资金来源。根据每年新诊断的患者数量和生存率来估算成本效益。
结果
儿科癌症病房 2016 年的运营成本为 520 万美元（每天治疗 90 名门诊患者，每年有 1385 名住院患者）。大约四分之三的成本（74.7％）归因于以下四项：人员（21.6％），病理诊断（11.5％），药房（化疗，支持性护理药物和营养；31.8％）和血液制品（9.8％）。资金来源包括政府（52.5％），慈善基金会（44.2％）和社会保障缴款计划（3.4％）。基于每年 181 名新患者和 5 年生存率为 48.5％，每避免一个残疾调整生命年的成本为 1624 美元，低于被认为非常具有成本效益的阈值。
结论
在低收入和中等收入国家的专门单位中治疗儿童癌症可以具有成本效益。慈善基金会的大力支持有助于降低成本。癌症 2018;124:391-7. ©2017 美国癌症协会。
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