Estimation of the financial burden to the national health insurance for patients with major cancers in Taiwan

被引:26
作者
Chu, Po-Ching [1 ]
Hwang, Jing-Shiang [2 ]
Wang, Jung-Der [1 ,3 ,4 ]
Chang, Yu-Yin [1 ]
机构
[1] Natl Taiwan Univ, Inst Occupat Med & Ind Hyg, Coll Publ Hlth, Taipei 100, Taiwan
[2] Acad Sinica, Inst Stat Sci, Taipei 11529, Taiwan
[3] Natl Taiwan Univ Hosp, Dept Internal Med, Taipei 100, Taiwan
[4] Natl Taiwan Univ Hosp, Dept Environm & Occupat Med, Taipei 100, Taiwan
关键词
cancer; health expenditure; health insurance; Monte Carlo method;
D O I
10.1016/S0929-6646(08)60008-X
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background/Purpose: Almost all countries that have national health insurance schemes face financial challenges. A better understanding of the financial burden that cancer places on Taiwan's National Health Insurance (NHI) is important for helping policy makers to plan tinder scarce healthcare resources. This study attempts to estimate lifetime health expenditure for patients with 17 types of major cancers. Methods: A total of 425,294 patients, each of whom was registered in Taiwan during 1990 to 2001 as having one of 17 major types of cancers, were included. All of them were followed until the end of 2004. Monte Carlo simulation was used to extrapolate survival for up to 600 months to derive the life expectancy or lifetime survival function after diagnosis for different cancers. The average annual health expenditure per case for each cancer type was calculated by using data from the NHI's reimbursement database. The lifetime health expenditure per case was estimated by multiplying the monthly survival probability by the average monthly health expenditure, adjusting for the annual discount rate and the medical care inflation rate. By incorporating the number of annual incidence cases, the total lifetime health expenditure can also be estimated. Results: Of the 17 cancers studied, it was found that leukemia had the highest average annual health expenditure per case (207,000 TWD) as well as the highest lifetime health expenditure per case (2,404,000 TWD, without discounting adjustment). Breast cancer had the highest total lifetime health expenditure (5046 million TWD) because of the longer life expectancy and chronic morbidity. Furthermore, colorectal cancer had the second highest total lifetime health expenditure (4995 million TWD) due to its high incidence. Conclusion: The proposed method is a feasible way of estimating lifetime health expenditure for cancer patients even under high censoring rates. This would be helpful for cost-effectiveness assessment of cancer prevention programs and for policy planning.
引用
收藏
页码:54 / 63
页数:10
相关论文
共 27 条
[1]   Clinical model of lifetime cost of treating bladder cancer and associated complications [J].
Avritscher, Elenir B. C. ;
Cooksley, Catherine D. ;
Grossman, H. Barton ;
Sabichi, Anita L. ;
Hamblin, Lois ;
Dinney, Colin P. ;
Elting, Linda S. .
UROLOGY, 2006, 68 (03) :549-553
[2]   The burden of illness of cancer: Economic cost and quality of life [J].
Brown, ML ;
Lipscomb, J ;
Snyder, C .
ANNUAL REVIEW OF PUBLIC HEALTH, 2001, 22 :91-113
[3]  
*BUR NAT HLTH INS, 2004, 2003 NAT HLTH INS AN
[4]   Community-based multiple screening model - Design, implementation, and analysis of 42,387 participants Taiwan community-based integrated screening group [J].
Chen, THH ;
Chiu, YH ;
Luh, DL ;
Yen, MF ;
Wu, HM ;
Chen, LS ;
Tung, TH ;
Huang, CC ;
Chan, CC ;
Shiu, MN ;
Yeh, YP ;
Liou, HH ;
Liao, CS ;
Lai, HC ;
Chiang, CP ;
Peng, HL ;
Tseng, CD ;
Yen, MS ;
Hsu, WC ;
Chen, CH .
CANCER, 2004, 100 (08) :1734-1743
[5]  
CUNNINGHAM K, COST ILLNESS HDB
[6]  
*DIR GEN BUDG ACC, 2004, COMM PRIC STAT MONTH, P21
[7]   Life expectancy of patients with newly-diagnosed HIV infection in the era of highly active antiretroviral therapy [J].
Fang, C. T. ;
Chang, Y. Y. ;
Hsu, H. M. ;
Twu, S. J. ;
Chen, K. T. ;
Lin, C. C. ;
Huang, L. Y. L. ;
Chen, M. Y. ;
Hwang, J. S. ;
Wang, J. D. ;
Chuang, C. Y. .
QJM-AN INTERNATIONAL JOURNAL OF MEDICINE, 2007, 100 (02) :97-105
[8]  
Fireman BH, 1997, HEALTH CARE FINANC R, V18, P51
[9]  
GARBER AM, 1996, COST EFFECTIVENESS H, P25
[10]   Estimation of reduced life expectancy from serious occupational injuries in Taiwan [J].
Ho, Jiune-Jye ;
Hwang, Jing-Shiang ;
Wang, Jung-Der .
ACCIDENT ANALYSIS AND PREVENTION, 2006, 38 (05) :961-968