| Objectives To understand the economic burden of six common cancers,in order to provide scientific data of cost-benefit analysis for promoting cancer screenings.To understand the cost,effect and cost-effectiveness of six common cancers screening,in order to provide a scientific evidence for future large-scale cancer screening and early detection and early treatment projects.Methods The hospital patients who with the six common cancers and their families in Lanzhou and Jinchang were selected as research population,during September,2012.The information such as hospitalization cost,direct medical cost,direct non-medical cost and nursing hours were obtained,and then analyze the economic burden.The high-risk groups were evaluated by "Anti-cancer risk assessment questionnaire "from the resident population aged 40-69 years old in Jinchang city,and then they were taken into the clinical examination.The cost-effectiveness analysis was performed after the costs and effects of screening were collected.Results 1.The average economic burden of the six common cancers was 57,127.27 Yuan,of which direct economic burden,indirect economic burden,direct medical costs and direct non-medical costs was 42,463.73 Yuan,14,663.54 Yuan,38,998.59 Yuan,and 3465.14 Yuan respectively.The total economic burden in descending order was lung cancer(69320.35 Yuan),breast cancer(60534.70 Yuan),esophageal cancer(59329.67 Yuan),colorectal cancer(57862.66 Yuan),stomach cancer(52526.31 Yuan)and liver can.cer(41645.31 Yuan).2.The total cost of six common cancer screening was 1,265,117.30 Yuan,of which at the risk assessment stage,at the clinical examination stage was 400,115.5 Yuan,865,001.80 Yuan;the screening cost of every person at the risk assessment stage was 24.58 Yuan;the screening cost of every person at the clinical examination stage capita cost of 1104.68 Yuan;the screening total cost of every person was 1129.26 Yuan.3.A total of 16,277 people were evaluated,of which 9007 people(13890 person-time)were high-risk and the high-risk rate was 85.34%.The highest high-risk rate was lung cancer,26.04%,followed was upper gastrointestinal cancer,21.22%,and-the lowest was liver cancer,13.37%.A total of 4872 person-time joined into the clinical examination,with a total participation rate of 33.08%,of which the highest participation rate was liver cancer of 59.15%,followed was breast cancer of 58.64%,the lowest was colorectal cancer of 9.54%.The cumulative constituent ratio of lung cancer,liver cancer and breast cancer was 86.88%.A total of 2349 person-time were precancerous lesion,with the rate of 48.21%,of which the highest rate was lung cancer of 96.08%,followed was upper gastrointestinal cancer of 45.30%,the lowest was liver cancer of 0.85%.A total of 45 cases suspicious cancer were found,including 16 cases of liver cancer,10 cases of breast cancer,and 19 cases of lung cancer,with the rate of 0.92%.4.Among the high-risk people of six common cancers,the number of one high-risk factor was 5541,with the high-risk of 34.04%,and the composition ratio was 61.52%;the number of two high-risk factors 2334,with the rate of 14.31%,and the constitutes ratio was 25.91%;with the increase of high-risk categories,the number of high-risk people reduced;the number of five high-risk factors was 24,with the high-risk of 0.15%,and the composition ratio was 0.27%.Among the clinical examination people,the number of who joined one clinical examination was 3445,with the constitutes ratio of 83.86%;the number of who joined two clinical examinations was 588,with the constituent ratio of 14.31%;with the number of clinical examination increasing,the number of clinical examination people reduced;the number of who joined four clinical examinations was 2,with the constituent ratio of 0.05%;the number of who joined five clinical examinations was 0.Among the precancerous lesion people,the number of one precancerous lesion was 2157,with the constituent ratio of 95.78%;the number of two precancerous lesions was 96,with the constituting rate of 4.26%.All of the suspicious cancers were single types of cancer.5.Among the high-risk people,the most common two kinds of high-risk combination was gastrointestinal and lung cancer with the number of 617(26.44%),followed was lung and colorectal cancer with the number of 324(13.88%),the lowest was colorectal and breast cancer with the number of 96(4.11%).Among the clinical examination people,the most common two clinical examinations combination was lung and liver cancer with the number of 186(31.63%),the number of combinations of lung,liver and breast cancer combinations were 374,with the constitute rate of 63.61%.6 Among the high-risk people,the most common three kinds of high-risk combination was gastrointestinal,lung and liver cancer with the number of 194(22.27%);the most common four kinds of high-risk combination was gastrointestinal,lung,liver and colorectal cancer with the number of 37(45.68%).Among the clinical examination people,the most common three clinical examinations combination was lung,liver and breast cancer with the number of 37(45.68%).7.The total cost of the six common cancer screening was 1,265,117.30 Yuan,of which at the risk assessment stage the cost-effectiveness ratio was 28.81 Yuan each one,the total cost-precancerous lesion effect ratio was 538.58 Yuan each one of every part,the total cost-suspicious cancer effect ratio was 28,113.72 Yuan each one,the total direct cost-suspicious cancer effect ratio was 18,308.14 Yuan each one.8.When the effect of the traditional single cancer screening was the same as the united screening,81,385 person-time would be evaluated,the total cost at the risk assessment stage would be 1,850,317.70 Yuan,with the cost-effectiveness ratio at the risk assessment stage would be 205.43 Yuan each one;the total cost of the traditional single cancer screening would be 2,715,319.50 Yuan,the average total cost-precancerous lesion effect ratio would be 1,155.95 Yuan each one of every part,the total cost-suspicious cancer effect ratio would be 60,340.43 Yuan each one.9.When the screening effect was the same,the six cancers screening could save 1,450,202.20 Yuan of the total cost than the traditional single cancer screening,while the cost would be saved at the risk assessment stage;the average cost of per high-risk people would be saved 104.40 Yuan at the risk assessment stage;the average cost of per precancerous lesion people of each part would be saved 617,37 Yuan;the average cost of per suspicious cancer people of each part would be saved 32,226.71 Yuan.10.There were 23.26%of the survey respondents didn't want to take participate in the screening,while the constitute rate of gastrointestinal cancers was 31.70%,28.55%,31.63%;the main reason was" no necessary"(46.51%),the followed reason was "examination was painful"(32.34%),while the reason of "examination was painful" in the gastrointestinal cancers was higher than the other three cancers;in the investigation after clinical examination,the constitute ratio of considering the clinical screening methods was acceptable was 91.91%,with 75.35%,80.40%,69.01%of the gastrointestinal cancers.Conclusions 1.The economic burden of the six common cancers was heavy,and the direct economic burden was higher than indirect,while the direct medical cost was the main.The total economic burden in descending order was lung cancer,breast cancer,esophageal cancer,colorectal cancer,stomach cancer and liver cancer.2.The high-risk rate with the cancer of the population was high,with the order of lung cancer,upper gastrointestinal cancer,breast cancer,colorectal cancer,liver cancer;the participation rate of clinical examination was higher in lung,liver,breast cancer than gastrointestinal cancer,especially the colorectal cancer.3.The most common two kinds of high-risk combination and clinical examination combination was upper gastrointestinal and lung cancer,lung and colorectal cancer;the most common three kinds of high-risk combination and clinical examination combination was gastrointestinal,lung and liver cancer,upper gastrointestinal,lung,and liver cancer;the most common four kinds of high-risk combination was lung,upper gastrointestinal,liver and colorectal cancer.4.The combined screening with six cancers could save cost,especially the cost at the risk assessment stage.5.Improving the participation rate of clinical examination could increase screening efficiency,especially the gastrointestinal participation rate.The method of painless and noninvasive in gastrointestinal cancer screening will effectively improve the efficiency of screening. |
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