Sunnybrook Research Institute (Mittmann, Seung) and Odette Cancer Centre (Look Hong, Earle, Cheung, Coburn, DeAngelis), Sunnybrook Health Sciences Centre; Cancer Care Ontario (Mittmann), Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (Mittmann), Ottawa, Ont.; ICES (Liu, Cheng, Saxena, Earle, Cheung, Coburn); Health Outcomes and PharmacoEconomic (HOPE) Research Centre (Seung); University Health Network (Leighl), Toronto, Ont.; McMaster University (Evans), Hamilton, Ont.
CMAJ Open. 2020 Mar 16;8(1):E191-E198. doi: 10.9778/cmajo.20190114. Print 2020 Jan-Mar.
Previous costing and resource estimates for cancer have not been complete owing to lack of comprehensive data on cancer-related medication and radiation treatment. Our objective was to calculate the mean overall costs per patient of cancer-related medications and radiation, as well as by disease subtype and stage, in the first year after diagnosis for the 4 most prevalent cancers in Ontario.
We conducted a retrospective cohort study using provincial health administrative databases to identify population health system resources and costs for all patients diagnosed with breast, colorectal, lung or prostate cancer between Jan. 1, 2010, and Dec. 31, 2015 in Ontario. The primary outcome measure was the overall average cost per patient in the 365 days after diagnosis for cancer-related medications and radiation treatment, calculated with the use of 2 novel costing algorithms. We determined the cost by disease, disease subtype and stage as secondary outcomes.
There were 168 316 Ontarians diagnosed with cancer during the study period, 50 141 with breast cancer, 38 108 with colorectal cancer, 34 809 with lung cancer and 45 258 with prostate cancer. The mean per-patient cost for cancer-related medications was $8167 (95% confidence interval [CI] $8023-$8311), $6568 (95% CI $6446-$6691), $2900 (95% CI $2816-$2984) and $1211 (95% CI $1175-$1247) for breast, colorectal, lung and prostate cancer, respectively. The corresponding mean radiation treatment costs were $18 529 (95% CI $18 415-$18 643), $15 177 (95% CI $14 899-$15 456), $10 818 (95% CI $10 669-$10 966) and $16 887 (95% CI $16 648-$17 125). In general, stage III and IV cancers were the most expensive stages for both medications and radiation across all 4 disease sites.
Our work updates previous costing estimates to help understand costs and resources critical to health care system planning in a single-payer system. More refined costing estimates are useful as inputs to allow for more robust health economic modelling and health care system planning.
由于缺乏癌症相关药物和放射治疗的综合数据，以往对癌症的成本和资源估计并不完整。我们的目的是计算安大略省四种最常见癌症患者在诊断后第一年与癌症相关的药物和放射治疗的平均总费用，以及按疾病亚型和分期计算的费用。
我们使用省级卫生行政数据库进行了一项回顾性队列研究，以确定 2010 年 1 月 1 日至 2015 年 12 月 31 日期间在安大略省被诊断患有乳腺癌、结直肠癌、肺癌或前列腺癌的所有患者的人群卫生系统资源和成本。主要观察结果是使用两种新的成本计算算法计算诊断后 365 天内与癌症相关的药物和放射治疗的每位患者的总体平均费用。我们还确定了按疾病、疾病亚型和分期计算的成本。
研究期间共有 168316 名安大略省人被诊断患有癌症，其中 50141 人患有乳腺癌，38108 人患有结直肠癌，34809 人患有肺癌，45258 人患有前列腺癌。与乳腺癌、结直肠癌、肺癌和前列腺癌相关的药物的每位患者的平均费用分别为 8167 美元（95%置信区间 [CI] 8023 美元至 8311 美元）、6568 美元（95% CI 6446 美元至 6691 美元）、2900 美元（95% CI 2816 美元至 2984 美元）和 1211 美元（95% CI 1175 美元至 1247 美元）。相应的平均放射治疗费用分别为 18529 美元（95% CI 18415 美元至 18643 美元）、15177 美元（95% CI 14899 美元至 15456 美元）、10818 美元（95% CI 10669 美元至 10966 美元）和 16887 美元（95% CI 16648 美元至 17125 美元）。一般来说，所有四个疾病部位的 III 期和 IV 期癌症在药物和放射治疗方面都是最昂贵的阶段。
我们的工作更新了以往的成本估算，以帮助了解在单一支付者系统中对卫生保健系统规划至关重要的成本和资源。更精确的成本估算作为输入，可用于更稳健的健康经济建模和卫生保健系统规划。
