“Factors associated with non-small cell lung cancer treatment costs in a Brazilian public hospital”

Abstract

BackgroundThe present study estimated the cost of advanced non-small cell lung cancer care for a cohort of 251 patients enrolled in a Brazilian public hospital and identified factors associated with the cost of treating the disease, considering sociodemographic, clinical and behavioral characteristics of patients, service utilization patterns and survival time.MethodsEstimates were obtained from the survey of direct medical cost per patient from the hospital’s perspective. Data was collected from medical records and available hospital information systems. The ordinary least squares (OLS) method with logarithmic transformation of the dependent variable for the analysis of cost predictors was used to take into account the positive skewness of the costs distribution.ResultsThe average cost of NSCLC was US$ 5647 for patients, with 71% of costs being associated to outpatient care. The main components of cost were daily hospital bed stay (22.6%), radiotherapy (15.5%) and chemotherapy (38.5%). The OLS model reported that, with 5% significance level, patients with higher levels of education, with better physical performance and less advanced disease have higher treatment costs. After controlling for the patient’s survival time, only education and service utilization patterns were statistically significant. Individuals who were hospitalized or made use of radiotherapy or chemotherapy had higher costs. The use of these outpatient and hospital services explained most of the treatment cost variation, with a significant increase of the adjusted R2 of 0.111 to 0.449 after incorporation of these variables in the model. The explanatory power of the complete model reached 62%.ConclusionsInequities in disease treatment costs were observed, pointing to the need for strategies that reduce lower socioeconomic status and population’s hurdles to accessing cancer care services.

<p>Costs and Cost Drivers Associated with Non-Small-Cell Lung Cancer Patients Who Received Two or More Lines of Therapy in Europe</p>

“…11 A chart review study of hospital-based costs from Brazil, however, suggested an effect of ECOG PS = 2 leading to lower total costs, which were potentially due to delayed rather than avoided costs. 12 ISC-IASLC disease stage was not a significant predictor in our study, potentially due to the study being restricted to patients with stage IIIB/IVaNSCLC, but was found a significant predictor in other chart reviews. 12,13 It may be that ISC-IASLC disease stage impacts indirect costs 14 or that ECOG PS was not included as an independent variable in these studies.…”

“…12 ISC-IASLC disease stage was not a significant predictor in our study, potentially due to the study being restricted to patients with stage IIIB/IVaNSCLC, but was found a significant predictor in other chart reviews. 12,13 It may be that ISC-IASLC disease stage impacts indirect costs 14 or that ECOG PS was not included as an independent variable in these studies. While other studies identified alcohol abuse as a prognostic factor for higher HCRU costs, it was correlated with significantly lower costs (total and per patient-month) in our study.…”

Perfil das internações por neoplasias no Sistema Único de Saúde: estudo de séries temporais

“…O tratamento oncológico apresenta alto custo em comparação com os demais tratamentos oferecidos pelo SUS. Estudo realizado por Barros Reis 10 demonstrou que o custo médio do tratamento oncológico no Brasil girou em torno de US$ 3.796,00 por paciente em 2011, sendo que 30% estão relacionados a internações hospitalares, e o restante abrange procedimentos ambulatoriais. Em levantamento sobre custos do tratamento do câncer cervical nos serviços públicos em 2006, Novaes et al 11 observaram que, de um montante de US$ 104.966.045, cerca de 8% foram destinados a internações clínicas.…”