a Department of Public Health, Faculty of Medicine , University of Helsinki , Helsinki , Finland.
b Industrial Management and Engineering , Aalto-yliopisto Tuotantotalouden laitos , Aalto , Finland.
Acta Oncol. 2018 Jul;57(7):983-988. doi: 10.1080/0284186X.2018.1438656. Epub 2018 Feb 16.
The cost of cancer and outcomes of cancer care have been discussed a lot since cancer represents 3-6% of total healthcare costs and cost estimations have indicated growing costs. There are studies considering the cost of all cancers, but studies focusing on the cost of disease and outcomes in most common cancer sites are limited. The objective of this study was to analyze the development of the costs and outcomes in Finland between 2009 and 2014 per cancer site.
The National cost, episode and outcomes data were obtained from the National register databases based on International Statistical Classification of Diseases (ICD)-10 diagnosis codes. Cost data included both the direct and indirect costs. Two hospitals were used to validate the costs of care. The outcome measures included relative survival rate, mortality, sick leave days per patient and number of new disability pensions.
The outcomes of cancer care in most common cancer sites have improved in Finland between 2009-2014. The real costs per new cancer patient decreased in seven out of ten most common cancer sites. The significance of different cost components differ significantly between the different cancer sites. The share of medication costs of the total cost of all cancers increased, but decreased for the five most common cancer sites.
The changes in the cost components indicate that the length of stay has shortened in special care and treatment methods have developed towards outpatient care. This partially explains the decrease of costs. Also, at the same time outcomes improved, which indicates that decrease in costs did not come at the expense of treatment quality. As the survival rates increase, the relevance of mortality measures decreases and the relevance of other, patient-relevant outcome measures increases. In the future, the outcomes and costs of health care systems should be assessed routinely for the most common patient groups.
自癌症占总医疗保健费用的 3-6%以来，癌症的成本及其治疗结果一直备受关注，且成本估算表明成本不断增加。有研究考虑了所有癌症的成本，但侧重于大多数常见癌症部位的疾病成本和治疗结果的研究有限。本研究的目的是分析 2009 年至 2014 年期间按癌症部位划分的芬兰的成本和结果的发展情况。
国家成本、发病和结果数据来源于国家登记数据库，这些数据基于国际疾病分类（ICD）-10 诊断代码。成本数据包括直接和间接成本。使用两家医院对护理成本进行验证。结果指标包括相对生存率、死亡率、每位患者的病假天数和新残疾抚恤金人数。
2009-2014 年期间，芬兰大多数常见癌症部位的癌症治疗结果有所改善。十种最常见癌症中有七种的新癌症患者的实际成本降低。不同癌症部位的成本构成的重要性差异显著。所有癌症药物成本占总成本的比例增加，但五种最常见癌症的比例下降。
成本构成的变化表明特殊护理的住院时间缩短，治疗方法向门诊护理发展。这在一定程度上解释了成本的下降。同时，治疗结果也得到了改善，这表明成本的降低并没有以牺牲治疗质量为代价。随着生存率的提高，死亡率指标的相关性降低，而其他与患者相关的结果指标的相关性增加。将来，应定期评估最常见患者群体的医疗保健系统的结果和成本。
