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.
Highlights
The 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
The present study aims to identify factors associated with direct cost variation of care for advanced non-small cell lung cancer, considering demographic, socioeconomic, clinical and behavioral characteristics of patients and the pattern of the service utilization at a reference hospital of the Unified Health System (SUS) in Rio de Janeiro, Brazil
Study subjects The study was based on secondary data from a retrospective cohort of patients diagnosed with Non-small cell lung cancer (NSCLC) stage IIIB / IV enrolled in the Chest Department, José Alencar Gomes da Silva National Cancer Institute (INCA), from January 1 to December 31, 2011
Summary
The number of patients corresponds to 90% of an initial cohort of 277 subjects, which included 26 patients whose monitoring was interrupted before the first year of observation [12] This follow-up loss may have been motivated by different factors, such as the abandonment of treatment or transfer of care to the private health services network, for example. Six nested models are analyzed to verify the linear relationship between the treatment cost logarithm and potential explanatory variables, as follows: Model 1 – including only demographic characteristics of patients; Model 2 - Model 1 and socioeconomic variables; Model 3 – Model 2 and lifestyle variables; Model 4 –Model 3 and clinical variables; Model 5 –Model 4 and variables related to the use of outpatient and hospital services; and Model 6 –Model 5 and death period of the patient. Managing multiple databases with the various cost components was performed with the Statistical Analysis System (SAS®) version 9.3b, while analyses presented here were conducted using Stata 15.0 (StataCorp, College Station, TX)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
