de Barros Reis Carla, Knust Renata Erthal, de Aguiar Pereira Claudia Cristina, Portela Margareth Crisóstomo
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, 7o andar, Rio de Janeiro, RJ, 21041-210, Brazil.
Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Praça da Cruz Vermelha 23 - 4o andar, sala 64. Centro. Rio de Janeiro, Rio de Janeiro, RJ, 20230-130, Brazil.
BMC Health Serv Res. 2018 Feb 17;18(1):124. doi: 10.1186/s12913-018-2933-0.
The present study estimated the cost of advanced non-small cell lung cancer care for a cohort of 251 patients enrolled in a Brazilian public hospital and identified factors associated with the cost of treating the disease, considering sociodemographic, clinical and behavioral characteristics of patients, service utilization patterns and survival time.
Estimates were obtained from the survey of direct medical cost per patient from the hospital's perspective. Data was collected from medical records and available hospital information systems. The ordinary least squares (OLS) method with logarithmic transformation of the dependent variable for the analysis of cost predictors was used to take into account the positive skewness of the costs distribution.
The average cost of NSCLC was US$ 5647 for patients, with 71% of costs being associated to outpatient care. The main components of cost were daily hospital bed stay (22.6%), radiotherapy (15.5%) and chemotherapy (38.5%). The OLS model reported that, with 5% significance level, patients with higher levels of education, with better physical performance and less advanced disease have higher treatment costs. After controlling for the patient's survival time, only education and service utilization patterns were statistically significant. Individuals who were hospitalized or made use of radiotherapy or chemotherapy had higher costs. The use of these outpatient and hospital services explained most of the treatment cost variation, with a significant increase of the adjusted R of 0.111 to 0.449 after incorporation of these variables in the model. The explanatory power of the complete model reached 62%.
Inequities in disease treatment costs were observed, pointing to the need for strategies that reduce lower socioeconomic status and population's hurdles to accessing cancer care services.
本研究估算了巴西一家公立医院收治的251例晚期非小细胞肺癌患者的治疗费用，并确定了与该疾病治疗费用相关的因素，同时考虑了患者的社会人口学、临床和行为特征、服务利用模式及生存时间。
从医院角度对每位患者的直接医疗费用进行调查估算。数据收集自病历和可用的医院信息系统。采用对因变量进行对数变换的普通最小二乘法（OLS）分析成本预测因素，以考虑成本分布的正偏态。
非小细胞肺癌患者的平均费用为5647美元，其中71%的费用与门诊治疗相关。费用的主要组成部分为每日住院床位费（22.6%）、放疗费（15.5%）和化疗费（38.5%）。OLS模型显示，在5%的显著性水平下，教育程度较高、身体状况较好且疾病分期较晚的患者治疗费用较高。在控制患者生存时间后，只有教育程度和服务利用模式具有统计学意义。住院或接受放疗或化疗的患者费用较高。这些门诊和住院服务的使用解释了大部分治疗费用的差异，将这些变量纳入模型后，调整后的R值从0.111显著提高到0.449。完整模型解释力达到62%。
观察到疾病治疗费用存在不平等现象，这表明需要采取策略来减少社会经济地位较低人群在获得癌症护理服务方面的障碍。
