Expenditure and financial burden for the diagnosis and treatment of colorectal cancer in China: a hospital-based, multicenter, cross-sectional survey

Springer Science and Business Media LLC - Tập 36 - Trang 1-15 - 2017
Hui-Yao Huang1, Ju-Fang Shi1, Lan-Wei Guo1,2, Ya-Na Bai3, Xian-Zhen Liao4, Guo-Xiang Liu5, A-Yan Mao6, Jian-Song Ren1, Xiao-Jie Sun7, Xin-Yu Zhu1,3, Le Wang1, Bing-Bing Song8, Ling-Bin Du9, Lin Zhu10, Ji-Yong Gong11, Qi Zhou12, Yu-Qin Liu13, Rong Cao14, Ling Mai15, Li Lan16, Xiao-Hua Sun17, Ying Ren18, Jin-Yi Zhou19, Yuan-Zheng Wang20, Xiao Qi21, Pei-An Lou22, Dian Shi1,3, Ni Li1, Kai Zhang1, Jie He1, Min Dai1
1Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
2Department of Cancer Epidemiology, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, P. R. China
3Institute of Epidemiology and Health Statistics, Lanzhou University, Lanzhou, P. R. China
4Hunan Office for Cancer Control and Research, Hunan Provincial Cancer Hospital, Changsha, P. R. China
5Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, P. R. China
6Public Health Information Research Office, Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, P. R. China
7Center for Health Management and Policy, Key Lab of Health Economics and Policy, Shandong University, Jinan, P. R. China
8Heilongjiang Office for Cancer Control and Research, Affiliated Cancer Hospital of Harbin Medical University, Harbin, P. R. China
9Zhejiang Office for Cancer Control and Research, Zhejiang Cancer Hospital, Hangzhou, P. R. China
10Teaching and Research Department, Affiliated Cancer Hospital of Xinjiang Medical University, Ürümqi, P. R. China
11Science and Education Department of Public Health Division, Shandong Tumor Hospital, Jinan, P. R. China
12Chongqing Office for Cancer Control and Research, Chongqing Cancer Hospital, Chongqing, P. R. China
13Cancer Epidemiology Research Center, Gansu Provincial Cancer Hospital, Lanzhou, P. R. China
14Department of Health Policy and Economic Research, Guangdong Provincial Institute of Public Health, Guangzhou, P. R. China
15Department of Institute of Tumor Research, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, P. R. China
16Institute of Chronic Disease Prevention and Control, Harbin Center for Disease Control and Prevention, Harbin, P. R. China
17Ningbo Clinical Cancer Prevention Guidance Center, Ningbo No. 2 Hospital, Ningbo, P. R. China
18Urban Office of Cancer Early Detection and Treatment, Tieling Central Hospital, Tieling, P. R. China
19Institute of Chronic Non-communicable Diseases Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, P. R. China
20Department of Economic Operation, Kailuan General Hospital, Tangshan, P. R. China
21Department of Occupational Medicine, Tangshan People’s Hospital, Tangshan, P. R. China
22Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, P. R. China

Tóm tắt

The increasing prevalence of colorectal cancer (CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China. We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan (CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup (hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure. A total of 2356 patients with a mean age of 57.4 years were included, 57.1% of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY. The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage I, II, III, and IV disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3% of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups (P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more, whereas those with a lower household income and those who underwent surgery spent less (all P < 0.05). For patients in China, direct expenditure for the diagnosis and treatment of CRC seemed catastrophic, and non-medical expenditure was non-ignorable. The financial burden varied among subgroups, especially among patients with different clinical stages of disease, which suggests that, in China, CRC screening might be cost-effective.

Tài liệu tham khảo

Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer, December 2013. http://globocan.iarc.fr. Accessed 2 Oct 2015. Chen W, Zheng R, Zeng H, Zhang S. The incidence and mortality of major cancers in China, 2012. Chin J Cancer. 2016;35(1):73. doi:10.1186/s40880-016-0137-8. Sullivan R, Peppercorn J, Sikora K, Zalcberg J, Meropol NJ, Amir E, et al. Delivering affordable cancer care in high-income countries. Lancet Oncol. 2011;12(10):933–80. doi:10.1016/s1470-2045(11)70141-3. Arndt V, Merx H, Stegmaier C, Ziegler H, Brenner H. Restrictions in quality of life in colorectal cancer patients over three years after diagnosis: a population based study. Eur J Cancer. 2006;42(12):1848–57. doi:10.1016/j.ejca.2006.01.059. Cotrim H, Pereira G. Impact of colorectal cancer on patient and family: implications for care. Eur J Oncol Nurs. 2008;12(3):217–26. doi:10.1016/j.ejon.2007.11.005. Maher J, McConnell H. New pathways of care for cancer survivors: adding the numbers. Br J Cancer. 2011;105(Suppl 1):S5–10. doi:10.1038/bjc.2011.417. Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR. Financial hardships experienced by cancer survivors: a systematic review. J Natl Cancer Inst. 2017;109(2):205. doi:10.1093/jnci/djw205. Girgis A, Lambert S, Johnson C, Waller A, Currow D. Physical, psychosocial, relationship, and economic burden of caring for people with cancer: a review. J Oncol Pract. 2013;9(4):197–202. doi:10.1200/jop.2012.000690. Shi JF, Shi CL, Yue XP, Huang HY, Wang L, Li J, et al. Economic burden of cancer in China during 1996–2014: a systematic review. Chinese Health Econ. 2016;38(12):929–41 (in Chinese). Yip W, Hsiao W. Harnessing the privatisation of China’s fragmented health-care delivery. Lancet. 2014;384(9945):805–18. doi:10.1016/s0140-6736(14)61120-x. Dai M, Shi JF, Li N. Cancer Screening Program in Urban China: the program design and the expectancies. Zhonghua Yu Fang Yi Xue Za Zhi. 2013;47(2):179–82 (in Chinese). Huang HY, Shi JF, Dai M. Reasearch progress in health economic evaluation of colorectal cancer screening in China. Zhonghua Yu Fang Yi Xue Za Zhi. 2015;8:747–51. doi:10.3760/cma.j.issn.0253-9624.2015.08.017 (in Chinese). National Bureau of Statistics of China. China statistical yearbook, 2015. http://www.stats.gov.cn/tjsj/ndsj/2015/indexch.htm. Accessed 5 Jun 2016 (in Chinese). Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health Aff (Millwood). 2007;26(4):972–83. doi:10.1377/hlthaff.26.4.972. Beijing Human Resources and Social Security Bureau. http://www.bjldgovcn/LDJAPP/search/searchdetailjsp?no=28109. Accessed 3 Jun 2015 (in Chinese). Huang HY, Shi JF, Guo LW, Zhu XY, Wang L, Liao XZ, et al. Expenditure and financial burden for common cancers in China: a hospital-based multicentre cross-sectional study. Lancet. 2016;388:S10. Lang K, Lines LM, Lee DW, Korn JR, Earle CC, Menzin J. Lifetime and treatment-phase costs associated with colorectal cancer: evidence from SEER-Medicare data. Clin Gastroenterol Hepatol. 2009;7(2):198–204. doi:10.1016/j.cgh.2008.08.034. Shankaran V, Jolly S, Blough D, Ramsey SD. Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. J Clin Oncol. 2012;30(14):1608–14. doi:10.1200/JCO.2011.37.9511. The World Bank. GDP per capita based on purchasing power parity (PPP). http://data.worldbank.org/indicator. Accessed 10 Oct 2015. Hall PS, Hamilton P, Hulme CT, Meads DM, Jones H, Newsham A, et al. Costs of cancer care for use in economic evaluation: a UK analysis of patient-level routine health system data. Br J Cancer. 2015;112(5):948–56. doi:10.1038/bjc.2014.644. Kriza C, Emmert M, Wahlster P, Niederlander C, Kolominsky-Rabas P. An international review of the main cost-effectiveness drivers of virtual colonography versus conventional colonoscopy for colorectal cancer screening: is the tide changing due to adherence? Eur J Radiol. 2013;82(11):e629–36. doi:10.1016/j.ejrad.2013.07.019. Xu WY, Shi W, Chen P. Analysis of economic burden of malignant tumor in-patients in Xinjiang. Ji Bing Jian Ce. 2006;21(1):38–40 (in Chinese). Yabroff KR, Borowski L, Lipscomb J. Economic studies in colorectal cancer: challenges in measuring and comparing costs. J Natl Cancer Inst Monogr. 2013;2013(46):62–78. doi:10.1093/jncimonographs/lgt001. Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 2005. Cheng XM, Wj Luo, Liu GX, Ma J, Meng QY, Wang XW, et al. Health Economics. Beijing: People’s Medical Publishing House; 2012 (in Chinese). Van Houtven CH, Ramsey SD, Hornbrook MC, Atienza AA, van Ryn M. Economic burden for informal caregivers of lung and colorectal cancer patients. Oncologist. 2010;15(8):883–93. doi:10.1634/theoncologist.2010-0005. Hopkins RB, Goeree R, Longo CJ. Estimating the national wage loss from cancer in Canada. Curr Oncol. 2010;17(2):40–9. Hanly P, Soerjomataram I, Sharp L. Measuring the societal burden of cancer: the cost of lost productivity due to premature cancer-related mortality in Europe. Int J Cancer. 2015;136(4):E136–45. doi:10.1002/ijc.29105. Hollenbeak CS, Short PF, Moran J. The implications of cancer survivorship for spousal employment. J Cancer Surviv. 2011;5(3):226–34. doi:10.1007/s11764-011-0175-9. Neuman P, Cubanski J, Desmond KA, Rice TH. How much ‘skin in the game’ do medicare beneficiaries have? The increasing financial burden of health care spending, 1997-2003. Health Aff (Millwood). 2007;26(6):1692–701. doi:10.1377/hlthaff.26.6.1692. Longo CJ, Fitch M, Deber RB, Williams AP. Financial and family burden associated with cancer treatment in Ontario, Canada. Support Care Cancer. 2006;14(11):1077–85. doi:10.1007/s00520-006-0088-8. Mathews M, West R, Buehler S. How important are out-of pocket costs to rural patients’ cancer care decisions? Can J Rural Med. 2009;14:54–60. Weaver KE, Rowland JH, Alfano CM, McNeel TS. Parental cancer and the family: a population-based estimate of the number of US cancer survivors residing with their minor children. Cancer. 2010;116(18):4395–401. doi:10.1002/cncr.25368. Shi Q, Smith TG, Michonski JD, Stein KD, Kaw C, Cleeland CS. Symptom burden in cancer survivors 1 year after diagnosis: a report from the American Cancer Society’s Studies of Cancer Survivors. Cancer. 2011;117(12):2779–90. doi:10.1002/cncr.26146. Puts MT, Tu HA, Tourangeau A, Howell D, Fitch M, Springall E, et al. Factors influencing adherence to cancer treatment in older adults with cancer: a systematic review. Ann Oncol. 2014;25(3):564–77. doi:10.1093/annonc/mdt433.
Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Tập 36

1-15

Thông tin tác giả