癌症护理对叙利亚难民的经济负担：基于人群的建模研究。
The economic burden of cancer care for Syrian refugees: a population-based modelling study.
机构信息
Global Health Institute, American University of Beirut, Beirut, Lebanon; Conflict and Health Research Group, School of Security Studies, King's College London, London, UK.
Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK; School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
出版信息
Lancet Oncol. 2020 May;21(5):637-644. doi: 10.1016/S1470-2045(20)30067-X.
BACKGROUND
Cancer represents a substantial health burden for refugees and host countries. However, no reliable data on the costs of cancer care for refugees are available, which limits the planning of official development assistance in humanitarian settings. We aimed to model the direct costs of cancer care among Syrian refugee populations residing in Jordan, Lebanon, and Turkey.
METHODS
In this population-based modelling study, direct cost per capita and per incident case for cancer care were estimated using generalised linear models, informed by a representative dataset of cancer costs drawn from 27 EU countries. A range of regression specifications were tested, in which cancer costs were modelled using different independent variables: gross domestic product (GDP) per capita, crude or age-standardised incidence, crude or age-standardised mortality, and total host country population size. Models were compared using the Akaike information criterion. Total cancer care costs for Syrian refugees in Jordan, Lebanon, and Turkey were calculated by multiplying the estimated direct cancer care costs (per capita) by the total number of Syrian refugees, or by multiplying the estimated direct cancer costs (per incident case [crude or age-standardised]) by the number of incident cancer cases in Syrian refugee populations. All costs are expressed in 2017 euros (€).
FINDINGS
Total cancer care costs for all 4·74 million Syrian refugees in Jordan, Lebanon, and Turkey in 2017 were estimated to be €140·23 million using the cost per capita approach, €79·02 million using the age-standardised incidence approach, and €33·68 million using the crude incidence approach. Under the lowest estimation, and with GDP and total country population as model predictors, the financial burden of cancer care was highest for Turkey (€25·18 million), followed by Lebanon (€6·40 million), and then Jordan (€2·09 million).
INTERPRETATION
Cancer among the Syrian refugee population represents a substantial financial burden for host countries and humanitarian agencies, such as the UN Refugee Agency. New ways to provide financial assistance need to be found and must be coupled with clear, prioritised pathways and models of care for refugees with cancer.
FUNDING
UK Research and Innovation Global Challenges Research Fund: Research for Health in Conflict-Middle East and North Africa region (R4HC-MENA).
背景
癌症对难民和收容国构成了巨大的健康负担。然而，目前尚无关于癌症治疗费用的可靠数据，这限制了人道主义环境下官方发展援助的规划。我们旨在为居住在约旦、黎巴嫩和土耳其的叙利亚难民群体建立癌症护理直接成本模型。
方法
在这项基于人群的模型研究中，使用广义线性模型估计了癌症护理的人均和每例癌症的直接成本，该模型基于来自 27 个欧盟国家的癌症成本代表性数据集。测试了一系列回归规范，其中使用不同的自变量来建模癌症成本：人均国内生产总值（GDP）、粗发病率或年龄标准化发病率、粗死亡率或年龄标准化死亡率以及东道国总人口规模。使用赤池信息量准则比较模型。通过将估计的直接癌症护理成本（人均）乘以叙利亚难民总数，或通过将估计的直接癌症成本（每例病例[粗发病率或年龄标准化]）乘以叙利亚难民人群中的癌症病例数，计算出约旦、黎巴嫩和土耳其的叙利亚难民的癌症总护理费用。所有成本均以 2017 年欧元（€）表示。
结果
使用人均成本法，2017 年，约旦、黎巴嫩和土耳其的 474 万叙利亚难民的癌症总护理费用估计为 1.4023 亿欧元，使用年龄标准化发病率法为 7902 万欧元，使用粗发病率法为 3368 万欧元。在最低估计值下，以 GDP 和全国总人口作为模型预测因子，癌症护理的经济负担在土耳其最高（2518 万欧元），其次是黎巴嫩（640 万欧元），然后是约旦（209 万欧元）。
解释
叙利亚难民群体中的癌症对收容国和联合国难民署等人道主义机构构成了巨大的经济负担。需要找到新的提供财政援助的方式，并且必须与为癌症难民提供明确、优先的治疗途径和模式相结合。
资助
英国研究与创新全球挑战研究基金：中东和北非地区健康研究（R4HC-MENA）。
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