College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea.
Lung Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, South Korea.
PLoS One. 2019 Feb 22;14(2):e0212878. doi: 10.1371/journal.pone.0212878. eCollection 2019.
We evaluated the survival rates and medical expenditure in patients with lung cancer using a nationwide claims database in South Korea. A retrospective observational cohort study design was used, and 2,919 lung cancer patients and their matched controls were included. Medical expenditures were analyzed with the Kaplan-Meier sample average method, and patients were categorized into 4 groups by operation and primary treatment method (i.e. Patients with operation: OP = surgery, OP+CTx/RTx = surgery with anti-cancer drugs or radiotherapy; Patients without operation: CTx/RTx = anti-cancer drugs or radiotherapy, Supportive treatment). The 5-year medical expenditure per case was highest in the OP+CTx/RTx group ($36,013), followed by the CTx/RTx ($23,134), OP ($22,686), and supportive treatment group ($3,700). Lung cancer-related anti-cancer drug therapy was the major cost driver, with an average 53% share across all patients. Generalized linear regression revealed that monthly medical expenditure in lung cancer patients, after adjustment for follow-up month, was approximately 3.1-4.3 times higher than that in the control group (cost ratio for OP = 3.116, OP+CTx/RTx = 3.566, CTx/RTx = 4.340, supportive treatment = 4.157). The monthly medical expenditure at end of life was estimated at $2,139 for all decedents, and approximately a quarter of patients had received chemotherapy in the last 3 months. In conclusion, this study presented the quantified treatment costs of lung cancer on various aspects compared with matched controls according to the treatment of choice. In this study, patients with operation incurred lower lifetime treatment costs than patients with CTx/RTx or supportive treatment, indicating that the economic burden of lung cancer was affected by treatment method. Further studies including both cancer stage and treatment modality are needed to confirm these results and to provide more information on the economic burden according to disease severity.
我们使用韩国全国索赔数据库评估了肺癌患者的生存率和医疗支出。采用回顾性观察队列研究设计，纳入了 2919 名肺癌患者及其匹配对照。使用 Kaplan-Meier 样本平均法分析医疗支出，根据手术和主要治疗方法将患者分为 4 组（即手术患者：OP=手术，OP+CTx/RTx=手术联合抗癌药物或放疗；非手术患者：CTx/RTx=抗癌药物或放疗，支持治疗）。OP+CTx/RTx 组（36013 美元）每例患者的 5 年医疗支出最高，其次是 CTx/RTx 组（23134 美元）、OP 组（22686 美元）和支持治疗组（3700 美元）。肺癌相关抗癌药物治疗是主要的成本驱动因素，所有患者的平均占比为 53%。广义线性回归显示，调整随访月后，肺癌患者的月医疗支出比对照组高出约 3.1-4.3 倍（OP 的成本比为 3.116，OP+CTx/RTx 为 3.566，CTx/RTx 为 4.340，支持治疗为 4.157）。所有死亡患者的临终月医疗支出估计为 2139 美元，约四分之一的患者在最后 3 个月接受了化疗。总之，与匹配对照相比，本研究根据治疗选择，从多个方面量化了肺癌的治疗成本。在这项研究中，接受手术的患者的终身治疗费用低于接受 CTx/RTx 或支持治疗的患者，这表明肺癌的经济负担受治疗方法的影响。需要进一步包括癌症分期和治疗方式的研究来证实这些结果，并根据疾病严重程度提供更多有关经济负担的信息。
