Abstract
BackgroundIt is evident that comorbidity exacerbate the complexity of the management of lung cancer, however, limited research has been conducted to investigate the impact of comorbidity on health service utilization and cost, as well as the treatment choice among lung cancer patients. We examined the association of comorbidity with medical service utilization, cost and treatment choice among lung cancer patients in China.MethodsWe used claims data from China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) between 2013 to 2016 and data from Hospital Information System (HIS) Database in Beijing Cancer Hospital (BCH). Elixhauser Comorbidity Index was used to assess comorbidity. Negative binomial regression, generalized linear model (GLM) with a gamma distribution and a log link, and logistic regression was applied to assess the associations between comorbidity and medical service utilization, cost and treatment choice, respectively.ResultsAmong 8655 patients with lung cancer, 31.3% of had at least one comorbid conditions. Having comorbidity was associated with increased number of annual outpatient visits (1.6, 95%CI: 1.3, 1.9) and inpatients admissions (0.8, 95%CI, 0.70, 0.90), increased outpatient (USD635.5, 95%CI: 490.3, 780.8) and inpatient expenditure (USD2 470.3, 95CI%: 1998.6, 2941.9), as well as increased possibility of choosing radio therapy (OR: 1.208, 95%CI:1.012–1.441) and chemotherapy (1.363, 1.196–1.554), and decreased possibility of choosing surgery (0.850, 0.730–0.989). The medical utilization and expenditure, the possibility of choosing radiotherapy increases, and the possibility of choosing surgery decreases with the increasing number of chronic conditions. There are variations in the association with medical service utilization and expenditure, and treatment choice among individuals with different types of comorbid conditions.ConclusionComorbidity among lung cancer patients restricts the potential treatment choices and poses an extra substantial health care burden. Our findings provide implications for both the clinical management and health service planning and financing for lung cancer patients.
Highlights
It is evident that comorbidity exacerbate the complexity of the management of lung cancer, limited research has been conducted to investigate the impact of comorbidity on health service utilization and cost, as well as the treatment choice among lung cancer patients
Based on medical insurance claims data, this study firstly presents the association of medical care service utilization, expenditure and treatment choice with comorbidity in lung cancer patients in urban China
The prevalence of comorbidity in urban China was lower than that in developed countries, which ranges from 43.3% in Sweden [7] to 87.3% in Scotland [8], the younger median age of Chinese lung cancer patients (65) in our study compare to > = 68 in study from developed countries) and the heterogeneity of data source may contribute to the difference [14]
Summary
It is evident that comorbidity exacerbate the complexity of the management of lung cancer, limited research has been conducted to investigate the impact of comorbidity on health service utilization and cost, as well as the treatment choice among lung cancer patients. We examined the association of comorbidity with medical service utilization, cost and treatment choice among lung cancer patients in China. Lung cancer remains one of the leading cause of cancer incidence and mortality throughout the world and it has imposed a substantial disease burden to global public health [1]. Lung cancer is one of the main contributors to cancer-caused disability adjusted life years (DALYs) in most nations [2] and patients diagnosed with lung cancer always experienced significant cost and medical service utilization. With the growing incidence and mortality rate, China has experienced a significant increase in the relative disease burden of lung cancer, with 12% of total DALYs from cancers in 1990 to 20% in 2008 [2]. According to the prediction of The World Health Organization, the annual number of new cases of lung cancer death in China will be over one million by 2025 [6], and the expenditure will become even more burdensome to the entire society as the rapid population aging
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