Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia.
Pharmacy Department, Hospital Keningau, Ministry of Health, Keningau, Sabah, Malaysia.
PLoS One. 2021 May 13;16(5):e0251760. doi: 10.1371/journal.pone.0251760. eCollection 2021.
Oral cancer has been recognized as a significant challenge to healthcare. In Malaysia, numerous patients frequently present with later stages of cancers to the highly subsidized public healthcare facilities. Such a trend contributes to a substantial social and economic burden. This study aims to determine the cost of treating oral potentially malignant disorders (OPMD) and oral cancer from a public healthcare provider's perspective. Medical records from two tertiary public hospitals were systematically abstracted to identify events and resources consumed retrospectively from August 2019 to January 2020. The cost accrued was used to estimate annual initial and maintenance costs via two different methods- inverse probability weighting (IPW) and unweighted average. A total of 86 OPMD and 148 oral cancer cases were included. The initial phase mean unadjusted cost was USD 2,861 (SD = 2,548) in OPMD and USD 38,762 (SD = 12,770) for the treatment of cancer. Further annual estimate of initial phase cost based on IPW method for OPMD, early and late-stage cancer was USD 3,561 (SD = 4,154), USD 32,530 (SD = 12,658) and USD 44,304 (SD = 16,240) respectively. Overall cost of late-stage cancer was significantly higher than early-stage by USD 11,740; 95% CI [6,853 to 16,695]; p< 0.001. Higher surgical care and personnel cost predominantly contributed to the larger expenditure. In contrast, no significant difference was identified between both cancer stages in the maintenance phase, USD 700; 95% CI [-1,142 to 2,541]; p = 0.457. A crude comparison of IPW estimate with unweighted average displayed a significant difference in the initial phase, with the latter being continuously higher across all groups. IPW method was shown to be able to use data more efficiently by adjusting cost according to survival and follow-up. While cost is not a primary consideration in treatment recommendations, our analysis demonstrates the potential economic benefit of investing in preventive medicine and early detection.
口腔癌已被视为医疗保健领域的重大挑战。在马来西亚，许多患者经常在高度补贴的公共医疗设施中出现癌症晚期。这种趋势导致了巨大的社会和经济负担。本研究旨在从公共医疗服务提供者的角度确定治疗口腔潜在恶性疾病（OPMD）和口腔癌的成本。从 2019 年 8 月至 2020 年 1 月，系统地从两家三级公立医院的病历中提取事件和资源消耗数据，进行回顾性分析。所产生的成本用于通过两种不同的方法——逆概率加权（Inverse Probability Weighting，IPW）和未加权平均来估计年度初始和维持成本。共纳入 86 例 OPMD 和 148 例口腔癌病例。未经调整的 OPMD 初始阶段平均费用为 2861 美元（SD=2548），癌症治疗费用为 38762 美元（SD=12770）。进一步根据 IPW 方法估计 OPMD、早期和晚期癌症的初始阶段年度费用分别为 3561 美元（SD=4154）、32530 美元（SD=12658）和 44304 美元（SD=16240）。晚期癌症的总体成本明显高于早期癌症，相差 11740 美元；95%置信区间[6，853 至 16695]；p<0.001。更高的手术护理和人员成本是造成更大支出的主要原因。相比之下，在维持阶段，两种癌症阶段之间没有发现显著差异，为 700 美元；95%置信区间[-1，1142 至 2541]；p=0.457。未经加权平均的 IPW 估计与粗略比较显示初始阶段存在显著差异，后者在所有组别中均持续升高。IPW 方法通过根据生存和随访情况调整成本，显示出能够更有效地利用数据。虽然成本不是治疗建议的主要考虑因素，但我们的分析表明，在预防医学和早期发现方面投资具有潜在的经济效益。
