Huang Shao-Yi, Chen Ho-Min, Liao Kai-Hsin, Ko Bor-Sheng, Hsiao Fei-Yuan
Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
BMJ Open. 2020 Oct 10;10(10):e036341. doi: 10.1136/bmjopen-2019-036341.
Cancers result in significant economic burdens on patients, health sectors and society. Reliable burden estimates will help guide resource allocation. This study aimed to perform a nationwide cost analysis of the direct and indirect costs of the top ten most costly cancers, and acute coronary syndrome (ACS), as a comparison, in Taiwan.
A population-based cohort study.
In total, 545 221 patients with newly diagnosed cancer (lung cancer, female breast cancer, colorectal cancer, liver cancer, oral cancer, leukaemia, prostate cancer, non-Hodgkin's lymphoma, gastric cancer and oesophageal cancer) and 170 879 patients with ACS between 2007 and 2014 were identified.
Direct medical costs were calculated from claims recorded in the National Health Insurance Research Database . Indirect costs, comprising morbidity-associated and mortality-associated productivity losses, were estimated from public life expectancy, average wage and employment data. The costs incurred in the 3 years after diagnosis were assessed. As a comparison, the cost of ACS was also estimated using the same study frame. A cost driver analysis was conducted to identify factors impacting cancer costs.
The cancers with the highest mean direct medical costs and total costs were leukaemia (US$28 464) and oesophageal cancer (US$81 775), respectively. Indirect costs accounted for over 50% of the total economic burden of most cancers, except for prostate cancer and female breast cancer. The costs of ACS were lower than those of most cancers. From the cost driver analysis, older age at diagnosis significantly (p<0.05) decreased the total cost of cancer; in contrast, male, tumour metastasis, comorbidities and treatment in medical centres increased the costs.
This study demonstrates the comprehensive economic burden of the top 10 most costly cancers in Taiwan. These results are valuable for optimising healthcare resource allocation.
癌症给患者、卫生部门和社会带来了巨大的经济负担。可靠的负担估计将有助于指导资源分配。本研究旨在对台湾十大最昂贵癌症以及作为对照的急性冠状动脉综合征（ACS）的直接和间接成本进行全国性成本分析。
一项基于人群的队列研究。
总共确定了2007年至2014年间545221例新诊断癌症患者（肺癌、女性乳腺癌、结直肠癌、肝癌、口腔癌、白血病、前列腺癌、非霍奇金淋巴瘤、胃癌和食管癌）以及170879例ACS患者。
直接医疗成本根据国民健康保险研究数据库中记录的理赔数据计算得出。间接成本包括与发病相关和与死亡相关的生产力损失，根据公共预期寿命、平均工资和就业数据进行估计。评估诊断后3年产生的成本。作为对照，ACS的成本也使用相同的研究框架进行估计。进行成本驱动因素分析以确定影响癌症成本的因素。
平均直接医疗成本和总成本最高的癌症分别是白血病（28464美元）和食管癌（81775美元）。除前列腺癌和女性乳腺癌外，间接成本占大多数癌症总经济负担的50%以上。ACS的成本低于大多数癌症。从成本驱动因素分析来看，诊断时年龄较大显著（p<0.05）降低了癌症的总成本；相反，男性、肿瘤转移、合并症和在医疗中心接受治疗会增加成本。
本研究展示了台湾十大最昂贵癌症的综合经济负担。这些结果对于优化医疗资源分配具有重要价值。
