Lillini Roberto, De Lorenzo Francesco, Baili Paolo, Iannelli Elisabetta, Del Campo Laura M, Pero Dina, Traclò Gianfranca, Sproviero Alessandro, Sant Milena, Perrone Francesco
Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.
Italian Federation of Cancer Patients Organization, FAVO, Via Barberini 11, 00187, Rome, Italy.
Eur J Health Econ. 2023 Nov;24(8):1309-1319. doi: 10.1007/s10198-022-01544-9. Epub 2022 Nov 22.
Out of Pocket costs (OOP) sustained by cancer patients also in public NHS contribute to disease-related financial toxicity. Aim of the study was to investigate the amount and the types of OOP sustained by Italian cancer patients for care services.
A sample survey was conducted by FAVO in December 2017-June 2018, in 39 adhering hospitals and 1289 patients diagnosed from 1985 to 2018, by standardized questionnaire inquiring on: yearly expenditure by cancer service, age, year of diagnosis, disease phase, cancer site, sex, marital status, education, residence. Univariate and multivariable regression analyses were performed between OOP and each variable. Multilevel mixed-effects negative binomial regression was used to assess the combined effects of patients characteristics on the differences in acquiring health services.
The yearly average OOP was 1841.81€, with the highest values for transports (359.34€) and for diagnostic examinations (259.82€). Significantly higher OOP were found in North and Centre than South and Islands (167.51 vs. 138.39). In the fully adjusted multivariable analysis, the variables significantly associated with higher than reference expenditure were: medium/high education (OR 1.22 [1.05-1.42], upper gastrointestinal tract cancer (OR 1.37 [1.06-1.77]), disease phase of treatments for cancer progression or pain therapy (OR 1.59 [1.30-1.93]).
Italian cancer patients in 2018 sustained OOP quite similar to those measured in 2012 to supplement NHS services. The main component of the OOP costs were diagnostic examination and transportation. The NHS should pay attention to potentiate its ability to answer unmet needs of patients with advanced cancer who are the most fragile ones.
Reinforcing the services where the main OOP expenses are located can help in promoting public health actions and reduce socio-economic needs that could compromise the receipt of optimal care along the whole disease course, from diagnosis to rehabilitation.
在英国国家医疗服务体系（NHS）中，癌症患者承担的自付费用（OOP）也会导致与疾病相关的经济毒性。本研究的目的是调查意大利癌症患者在护理服务方面承担的自付费用的数额和类型。
2017年12月至2018年6月，FAVO在39家附属医院对1289例于1985年至2018年期间确诊的患者进行了抽样调查，采用标准化问卷询问：癌症服务的年度支出、年龄、诊断年份、疾病阶段、癌症部位、性别、婚姻状况、教育程度、居住地。对自付费用与每个变量进行单变量和多变量回归分析。采用多水平混合效应负二项回归评估患者特征对获得医疗服务差异的综合影响。
年度平均自付费用为1841.81欧元，其中交通费用（359.34欧元）和诊断检查费用（259.82欧元）最高。北部和中部地区的自付费用明显高于南部和岛屿地区（167.51欧元对138.39欧元）。在完全调整的多变量分析中，与高于参考支出显著相关的变量有：中等/高等教育程度（OR 1.22 [1.05 - 1.42]）、上消化道癌症（OR 1.37 [1.06 - 1.77]）、癌症进展或疼痛治疗阶段（OR 1.59 [1.30 - 1.93]）。
2018年意大利癌症患者承担的自付费用与2012年测量的费用相当，用于补充NHS服务。自付费用的主要组成部分是诊断检查和交通费用。NHS应注意增强其满足晚期癌症患者未满足需求的能力，这些患者是最脆弱的群体。
加强主要自付费用所在的服务可以有助于促进公共卫生行动，并减少可能在从诊断到康复的整个病程中影响获得最佳护理的社会经济需求。
