Study On The Epidemiology Characteristics And Economic Burden Of Lung Cancer Patients In Shanghai

OBJECTIVE:To analyze the epidemiological characteristics and the economic burden of patients with lung cancer in Shanghai and to put up with the reasonable suggestion on controlling or reducing the patient’s economic burden, to which the decision makers could referred to optimize the allocation of the restricted hygiene resources, to reduce the disease burden, and to facilitate the project of tumor control and prevention for the whole population.METHODS:The clinical characteristics and the expenditure for treatment of lung cancer of local patients in Shanghai Hospital in2009were studied by combining the methodology of epidemiology and health care economics. We used Excel2003to set a data base, Stata12.0to do the statistical analysis and report the economic burden of lung cancer patients, describing and estimating the consumption of medical resources. Pearson χ2was used to test the differences of demographic characters and clinical features of the patients, and Kaplan Meier method to calculate survival rate and compared among different clinical features. The expenses of different clinical stages and treatment were compared by Kruskal-Wallis tests, and the linear regression was adopted to analyze the influencing factors of the average expenses for each visit, each hospitalization and each out-patient visit.RESULTS:There were1272Shanghai patients with lung cancer being hospitalized in Shanghai Chest Hospital in2009and were followed up till December31th2012. Among these cases,626patients are still alive,3cases were lost, and2case with missing history.According to the epidemiological study, difference existed between male and female patients with respect to age, smoking, clinical features and histological type. The first-diagnosed age of both male and female clustered in the age distribution of40to79years to a maximum of60to69years. The average age of female patients were younger than that of male. Smoking rate among male was significantly higher than that among female. Female patients had a higher percentage of tumor history than male. Peripheral type lung cancer was common in both male and female. Of all the pathological types, the percentage of adenocarcinoma in female was up to85.61%, much higher than other types, while in male, it took a slightly higher percentage than other types. Most patients with lung cancer were at stage Ⅲ and Ⅳ, and there were more females at stage IV. The number of patients who visited doctors due to symptoms was2.35times that due to physical checks. Patients who visited doctors due to symptoms were mostly at stage Ⅲ and Ⅳ while those owed to physical checks at stage Ⅰ and Ⅱ. There were52.7%of the total patients receiving surgeries. The1year,2year and3year survival rates of lung cancer patients were69.97%,52.59%and46.82%, respectively. The average survival time was0.94years and the median1.35years. Factors like gender, age, histological types, stages and treatment were proved to have signifant influence on the prognosis of lung cancer patients.The study on economic burden showed that the lung cancer patients had a severe economic burden. In2009, the average expense was63292.9RMB for each lung cancer patient, of which46.02%, namely29129.27RMB was paid by patients themselves. The direct expense, holding a percentage of92.8%of the total average, was58709.37RMB per case, of which41.81%was out-of-pocket expenses. The indirect expense was4583.58RMB per case, which accounted for7.2%of the total average. Patients with and without medical insurances should pay7222.26RMB and27017.92RMB per case, respectively. As a result, the medical insurance took effect in reducing the direct economic burden of lung cancer patients and preventing patients from poverty due to diseases to some extent. There were still large numbers of patients, however, could not prevent themselves from poverty because of diseases.CONCLUSION:As there existed differences in clinical features, histological types, and treatment among lung cancer patients, the economic burden varied from patient to patient. The lung cancer patients should be detected earlier, diagnosed earlier and treated earlier in order to gain the time for a better cure, and meanwhile reducing the economic burden. The coverage of medical insurance should be enlarged, the medical process standardized, and the medical resources utterly utilized, so the medical expense would be brought down. Besides, enhancing social support and improving levels and ways of medical aids could concretely alleviate patients’ economic burden. Last, the consciousness of the entire population for diseases prevention should be elevated through reinforcing the health education, encouraging a healthy life style, and broadening the knowledge of cancer prevention towards patients.