Abstract
BackgroundDespite the high cost of initial cancer care, that is, care in the first year after diagnosis, limited information is available for specific categories of cancer-related costs, especially costs for specific services. This study purposed to identify causes of change in cancer treatment costs over time and to perform trend analyses of the percentage of cancer patients who had received a specific treatment type and the mean cost of care for patients who had received that treatment.Methodology/Principal FindingsThe analysis of trends in initial treatment costs focused on cancer-related surgery, chemotherapy, radiation therapy, and treatments other than active treatments. For each cancer-specific trend, slopes were calculated for regression models with 95% confidence intervals. Analyses of patients diagnosed in 2007 showed that the National Health Insurance (NHI) system paid, on average, $10,780 for initial care of a gastric cancer patient and $10,681 for initial care of a lung cancer patient, which were inflation-adjusted increases of $6,234 and $5,522, respectively, over the 1996 care costs. During the same interval, the mean NHI payment for initial care for the five specific cancers increased significantly (p<0.05). Hospitalization costs comprised the largest portion of payments for all cancers. During 1996–2007, the use of chemotherapy and radiation therapy significantly increased in all cancer types (p<0.05). In 2007, NHI payments for initial care for these five cancers exceeded $12 billion, and gastric and lung cancers accounted for the largest share.Conclusions/SignificanceIn addition to the growing number of NHI beneficiaries with cancer, treatment costs and the percentage of patients who undergo treatment are growing. Therefore, the NHI must accurately predict the economic burden of new chemotherapy agents and radiation therapies and may need to develop programs for stratifying patients according to their potential benefit from these expensive treatments.
Highlights
The growing incidence of cancer in aging populations and the use of new diagnostic technologies and targeted treatments are expected to result in increased cancer care costs
The National Health Research Institute (NHRI) maintains the NHI Research Database (NHIRD) based on data provided by the Bureau of National Health Insurance (BNHI)
The cohort in this study included 141,772 fee-for-service NHI beneficiaries diagnosed with lung cancer, liver cancer, colorectal cancer, gastric cancer, or female breast cancer during 1996-2007 (Table 1), which was the period during which the initial care costs for these five specific cancers significantly increased (p,0.05)
Summary
The growing incidence of cancer in aging populations and the use of new diagnostic technologies and targeted treatments are expected to result in increased cancer care costs. In the United States, the cancer incidence rate in patients aged 65 and older declined by 10% from 1992 to 2002. According to the Taiwan Ministry of Health and Welfare, cancer has been one of the ten most common causes of death since 1982. Since 2010, oral cancer replaced gastric cancer as the fourth most common cancer type [1,2]. These high incidence and mortality rates result in major medical expenditures and large socioeconomic impacts on patients, their families, and the society as a whole. This study purposed to identify causes of change in cancer treatment costs over time and to perform trend analyses of the percentage of cancer patients who had received a specific treatment type and the mean cost of care for patients who had received that treatment
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