Suryanegara Fithria Dyah Ayu, Iskandar Deni, Ekaputra Ericko, Kuntjoro Eko, Setiawan Didik, Postma Maarten Jacobus, de Jong Lisa Aniek
Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Pharmacy, Universitas Islam Indonesia, Yogyakarta, Indonesia.
BMC Health Serv Res. 2025 May 28;25(1):766. doi: 10.1186/s12913-025-12849-9.
Breast cancer is the most common cancer in Indonesia, and radiotherapy plays an essential role in its treatment. However, since 2016, the INA-CBGs (Indonesian Case-Based Groups) tariffs for radiotherapy have remained unchanged. This study aimed to assess the disparity between tariffs and actual costs of outpatient radiotherapy in breast cancer, using real-world data from two Indonesian hospitals.
We conducted a retrospective cohort study in a national public referral hospital and a private hospital. Breast cancer claims data were collected from 2017 to 2022 from the Department of Accounting/Finance with INA-CBGs tariff code of C-3-10-0 (radiotherapy procedures for outpatients). We estimated total actual costs, actual costs per patient and visit, and the cost-tariffs ratio. Differences between the actual costs and tariffs were analyzed using Mann-Whitney test.
A total of 3,890 breast cancer patients were included in the study, of which 74.4% were from the national public referral hospital. In the national public referral hospital and private hospital, the total actual costs of outpatient radiotherapy in breast cancer were USD 19,028,791.17 and USD 5,279,980.74, with median costs per patient of USD 6,560.00 [3,679.81;7,518.46] and USD 5,110.00 [839.15;7,552.34], and median costs per visit of USD 272.00 [253.16;274.47] and USD 272.00 [211.31;305.50], respectively. Over the study period, the cost-tariffs ratio was 86.85% and 59.07% in the national public referral hospital and private hospital, respectively. The differences between the tariffs and total actual costs were statistically significant in both hospitals and increased throughout the years.
For both hospitals, the INA-CBGs tariffs for outpatient radiotherapy services for breast cancer were insufficient to fully cover the actual costs during the review period. Furthermore, the difference between the tariffs and the actual costs increased over the years, emphasizing the need for revision of the C-3-10-0 tariffs. It is crucial to ensure coverage of all actual costs to ensure the sustainability, accessibility, and availability of radiotherapy treatment for breast cancer patients in Indonesia.
乳腺癌是印度尼西亚最常见的癌症，放射治疗在其治疗中起着至关重要的作用。然而，自2016年以来，印度尼西亚基于病例分组（INA-CBGs）的放射治疗费用一直没有变化。本研究旨在利用印度尼西亚两家医院的真实世界数据，评估乳腺癌门诊放射治疗费用与实际成本之间的差异。
我们在一家国家公立转诊医院和一家私立医院进行了一项回顾性队列研究。从会计/财务部门收集了2017年至2022年乳腺癌索赔数据，其INA-CBGs关税代码为C-3-10-0（门诊放射治疗程序）。我们估计了总实际成本、每位患者每次就诊的实际成本以及成本-费用比率。使用曼-惠特尼检验分析实际成本与费用之间的差异。
共有3890例乳腺癌患者纳入研究，其中74.4%来自国家公立转诊医院。在国家公立转诊医院和私立医院，乳腺癌门诊放射治疗的总实际成本分别为19,028,791.17美元和5,279,980.74美元，每位患者的中位数成本分别为6560.00美元[3679.81；7518.46]和5110.00美元[839.15；7552.34]，每次就诊的中位数成本分别为272.00美元[253.16；274.47]和272.00美元[211.31；305.50]。在研究期间，国家公立转诊医院和私立医院的成本-费用比率分别为86.85%和59.07%。两家医院的费用与总实际成本之间的差异均具有统计学意义，且逐年增加。
对于两家医院而言，INA-CBGs的乳腺癌门诊放射治疗服务费用在审查期间不足以完全覆盖实际成本。此外，费用与实际成本之间的差异逐年增加，强调需要修订C-3-10-0费用。确保覆盖所有实际成本对于保证印度尼西亚乳腺癌患者放射治疗的可持续性、可及性和可获得性至关重要。
