Scientific Promotion, General Hospital of Alessandria, Alessandria, Italy.
Department of Management, University of Turin, Turin, Italy.
Int J Health Policy Manag. 2018 Aug 1;7(8):728-737. doi: 10.15171/ijhpm.2018.13.
The current economic constraints cause hospital management to use the available public resources as rationally as possible. At the same time, there is the necessity to improve current scientific knowledge. This is even more relevant in the case of patients with malignant pleural mesothelioma (MPM), given the severity of the disease, its dismal prognosis, and the cost of chemotherapy drugs. This work aims to evaluate the standard cost of patients with MPM, supporting physicians in their decision-making process in relation to budget constraints, as well as policy-makers with respect research policy.
The authors conducted a retrospective cost analysis on all the patients with MPM who were first admitted to a reference hospital specialized in MPM care between 2014 and 2015, collecting data on their diagnostic pathways and active treatments, as well as on the related official fees for each procedure. Then, using a multiple regression model, we estimated the overall expected cost of a patient with MPM treated in our hospital, to be born by the Regional Healthcare System based on the chosen clinical pathway.
According to results, the economic impact of caring for a patient with MPM is mostly related to the selected active treatments, with drug and hospitalization costs as main drivers. Our analysis suggests that the expected reimbursed fee to care for a patient with MPM is equal to € 18 214.99, with chemotherapy and monitoring costs equal to € 12 861.43 and hospitalization cost equal to € 5353.55. This cost decreases to € 320.18 in the case of enrollment in an experimental trial of first-line treatment. In the other cases (second-line or third-line trials), the expected cost borne by the healthcare system for treating patients grows exponentially (€ 40,124.18 and € 59 839.94, respectively).
Experimental trials might be a solution to decrease the economic burden for the public healthcare system only in the case of first-line treatments, where the cost of chemotherapy is relevant. Nevertheless, policy-makers have to accept the sharing of this economic burden between society and the pharmaceutical industry to broaden the current scientific knowledge.
当前的经济限制促使医院管理层尽可能合理地利用现有公共资源。同时，有必要提高当前的科学知识水平。在恶性胸膜间皮瘤（MPM）患者的情况下，这一点更为重要，因为该疾病的严重程度、预后不佳以及化疗药物的成本都很高。这项工作旨在评估 MPM 患者的标准成本，为医生在预算限制下的决策过程提供支持，同时为政策制定者提供研究政策方面的参考。
作者对 2014 年至 2015 年间首次入住一家专门治疗 MPM 的参考医院的所有 MPM 患者进行了回顾性成本分析，收集了他们的诊断途径和积极治疗以及与每个程序相关的官方费用的数据。然后，使用多元回归模型，我们根据所选临床途径，估计了我们医院治疗的 MPM 患者的总体预期成本，这些成本将由区域医疗保健系统承担。
根据结果，照顾 MPM 患者的经济影响主要与所选的积极治疗有关，药物和住院费用是主要驱动因素。我们的分析表明，照顾 MPM 患者的预期报销费用等于 18214.99 欧元，化疗和监测费用等于 12861.43 欧元，住院费用等于 5353.55 欧元。如果参加一线治疗的实验性试验，这个费用会减少到 320.18 欧元。在其他情况下（二线或三线试验），医疗保健系统为治疗患者承担的预期费用呈指数增长（分别为 40124.18 欧元和 59839.94 欧元）。
实验性试验可能是降低公共医疗保健系统经济负担的一种方法，仅在化疗成本相关的一线治疗中有效。然而，政策制定者必须接受将这一经济负担在社会和制药行业之间分担，以扩大当前的科学知识。
