Analysis Of Direct Economic Burden Of Cancer During Hospitalization In Tianjin

Objects Non-communicable diseases(NCDs)caused 39.5 million deaths globally accounting for 72.3% of total 264 causes of death,and neoplasms caused 8.93 million deaths globally just lower than cardiovascular diseases(17.6 million deaths).And,global annual spending on anticancer drugs was around US$100 billion in 2016 and was predicted to rise to US$150 billion by 2020.From 2011 to 2015,the payments of cancer inpatients in China have increased by 84.1% and the total inpatient payments reached 177.1 billion RMB in 2015,accounting for 4.3% of the total health expenditure in China.Cancer has brought catastrophic economic burden for both society and individuals.But,detailed quantified individual economic burden among cancer sites and age-groups remains to be done.Methods A population based 50% stratified sampling were conducted in Tianjin Basic Medical Insurance Register System(TBMIRS)database.We obtained costs for drugs,tests,treatment,material,Chinese herbs and others for 58 cancer sites.Age-group analysis was performed with both sexes using ICD-10 and ICD-3 for coding cancer sites.Generalized linear model with gaussian distribution and log link was used for modeling,and visualizations of economic burden pattern was available for 58 cancer sites and it was also done for age-groups.Findings In total,costs of malignant hematonosis cancers(70 998.64 CNY),cancers of digestive organs(55 282.99 CNY)accounted for most economic burden compared to other sites.Lung cancer(66 35.216 CNY)had the highest number of cases and costs slightly above average costs for all sites combined.Malignant hematonosis cancers did great harm on both sexes and especially for child and youth,but with small number of cases.Catastrophic economic burden was shown in ovarian cancer(6 2280.00 CNY).As for age trend,almost all cancer sites showed degressive costs among aged people,and lung cancer peaked at young middle-aged people(66 35.216CNY)with relatively small cases.Cancers of digestive organs(67 710.47 CNY)were of both high economic burden and prevalence,and costs peaked just at age-groups that were at higher risks.Considering the consensus,guidelines and economic burden of cancer screening in specific sites,we find that the domestic guidelines are less targeted,often lack clinical evidence,which cannot guarantee the effectiveness of screening and the existence of its cost-effectiveness.At the same time,insufficient attention has been paid to some cancers,such as ovarian cancer and leukemia in AYAs population.The economic burden of these cancers is extremely heavy and there is no good prevention mechanism.Interpretation Our results show costs pattern among 58 cancer sites with wide differences,which need to be handled carefully for different sites.Age trend shows target population should be concluded based on risks and economic burden,which is of great value for screening.To ensure the robustness of screening,detailed study need to be done with not only considering reduction of incidence and mortality but also catastrophic economic burden.Strengthening cancer registration system to collect complete and standardized data on cancer incidence,morbidity and death,and strengthening targeted economic burden and cost-benefit research are the fundamental methods to solve the burden of cancer disease.