Medical expenditures for colorectal cancer diagnosis and treatment: A 10-year high-level-hospital-based multicenter retrospective survey in China, 2002−2011

Abstract

ObjectiveColorectal cancer (CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China.MethodsFrom 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan (CNY) using 2011 values.ResultsOf the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stage-I cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval (95% CI): 37,282−38,522], and the annual average increase rate was 9.2% from 2002 to 2011 (P for trend <0.001), with a cumulative increase of 2.4 times (from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages I, II, III and IV were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively (P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion (52.6%).ConclusionsThese conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.

Clinical characteristics, medical service utilization, and expenditure for colorectal cancer in China, 2005 to 2014: Overall design and results from a multicenter retrospective epidemiologic survey

“…Along with economic development and price inflation from 2011 through 2014, it is believed that differences between our current report and a previous study 4 stem from the availability of diagnostic and treatment options (such as the increasing use of CT). In addition, these differences also may be a result of extensive data quality control; for example, the 95th percentile (P 95 ) for the number of clinical visits per patient with CRC in the current survey was 10, which was higher than that in a previous report (P 95 = 7) 4 . Our average expenditure also was higher than that in a previous cross‐sectional study in which the average medical expenditure per patient with CRC during 2012 through 2014 was estimated as 61,829 CNY (year‐2014 value) 5 .…”

“…Our expenditure estimates are higher than previously published data. A similarly designed study estimated that the average medical expenditure per patient with CRC was 37,902 CNY in 2002 through 2011 and 48,163 CNY in 2009 through 2011 (year‐2011 value), which was regarded as a conservative estimate at tertiary hospitals in China 4 . Along with economic development and price inflation from 2011 through 2014, it is believed that differences between our current report and a previous study 4 stem from the availability of diagnostic and treatment options (such as the increasing use of CT).…”

“…A similarly designed study estimated that the average medical expenditure per patient with CRC was 37,902 CNY in 2002 through 2011 and 48,163 CNY in 2009 through 2011 (year‐2011 value), which was regarded as a conservative estimate at tertiary hospitals in China 4 . Along with economic development and price inflation from 2011 through 2014, it is believed that differences between our current report and a previous study 4 stem from the availability of diagnostic and treatment options (such as the increasing use of CT). In addition, these differences also may be a result of extensive data quality control; for example, the 95th percentile (P 95 ) for the number of clinical visits per patient with CRC in the current survey was 10, which was higher than that in a previous report (P 95 = 7) 4 .…”

“…In additional, the burden of CRC‐related disability‐adjusted life‐years has increased over the past decades and is expected to continuously increase both in China and worldwide 3 . Studies have indicated that medical expenditures associated with a CRC diagnosis and subsequent treatment increased rapidly from 2002 to 2011, 4 and the overall direct medical expenditure per CRC patient in China was 61,829 Chinse Yuan (CNY), exceeding the per capita gross domestic product of 46,652 CNY in 2014 5 . Based on a population‐level study informed by a database of 350 million inpatient medical records, in total, expenditures of 16.61 billion CNY were associated with CRC‐related hospitalizations in China in 2015 6 …”

Determinants of Participation and Detection Rate of Colorectal Cancer From a Population-Based Screening Program in China

“…Colonoscopy with biopsies for histologic confirmation has been shown to significantly reduce CRC mortality through early detection of cancer or removal of adenomatous polyps (5). However, colonoscopy is an invasive procedure requiring a high level of expertise, with a high cost (6,7). In countries with moderate or low CRC incidence and limited medical resources, it is recommended to use a risk stratification scoring system to select high-risk patients for colonoscopy (8,9).…”