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

摘要:

Background: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.Methods: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.Results: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,Ⅲll,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).Conclusions: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.

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作者单位: Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing 100021,P.R.China [1] Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing 100021,P.R.China;Department of Cancer Epidemiology, Henan Cancer Hospital,Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R.China [2] Institute of Epidemiology and Health Statistics, Lanzhou University, Lanzhou, Gansu 730000, P.R.China [3] Hunan Office for Cancer Control and Research, Hunan Provincial Cancer Hospital, Changsha, Hunan 410006, P.R.China [4] Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, Heilongjiang 150081, P.R.China [5] Public Health Information Research Office, Institute of Medical Information,Chinese Academy of Medical Sciences, Beijing 100020, P.R.China [6] Center for Health Management and Policy, Key Lab of Health Economics and Policy, Shandong University, Jinan, Shandong 250012, P.R.China [7] Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing 100021,P.R.China;Institute of Epidemiology and Health Statistics, Lanzhou University, Lanzhou, Gansu 730000, P.R.China [8] Heilongjiang Office for Cancer Control and Research, Affiliated Cancer Hospital of Harbin Medical University, Harbin, Heilongjiang 150081, P.R.China [9] Zhejiang Office for Cancer Control and Research, Zhejiang Cancer Hospital, Hangzhou,Zhejiang 310022, P.R.China [10] Teaching and Research Department, Affiliated Cancer Hospital of Xinjiang Medical University,(U)rümqi, Xinjiang 830011, P.R.China [11] Science and Education Department of Public Health Division,Shandong Tumor Hospital, Jinan, Shandong 250117, P.R.China [12] Chongqing Office for Cancer Control and Research, Chongqing Cancer Hospital, Chongqing 400030, P.R.China [13] Cancer Epidemiology Research Center, Gansu Provincial Cancer Hospital, Lanzhou, Gansu 730050, P.R.China [14] Department of Health Policy and Economic Research, Guangdong Provincial Institute of Public Health, Guangzhou, Guangdong 511430, P.R.China [15] Department of Institute of Tumor Research, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R.China [16] Institute of Chronic Disease Prevention and Control, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang 150081, P.R.China [17] Ningbo Clinical Cancer Prevention Guidance Center, Ningbo No.2 Hospital,Ningbo, Zhejiang 315010, P.R.China [18] Urban Office of Cancer Early Detection and Treatment, Tieling Central Hospital,Tieling, Liaoning 112000, P.R.China [19] Institute of Chronic Non-communicable Diseases Prevention and Control,Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu 210009, P.R.China [20] Department of Economic Operation, Kailuan General Hospital, Tangshan, Hebei 063000, P.R.China [21] Department of Occupational Medicine, Tangshan People's Hospital,Tangshan, Hebei 063000, P.R.China [22] Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, Jiangsu 221006, P.R.China [23]
期刊: 《癌症(英文版)》2017年36卷8期 352-366页 ISTICCA
栏目名称: Original Article
DOI: 10.1186/s40880-017-0209-4
基金项目:
This study was supported by the grants from the Beijing Hope Run Special Fund National Natural Science Foundation of China Specialized Research Fund for the Doctoral Program of Higher Education The National Health and Family Planning Committee of P.R.China
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