| ObjectivesThe objectives of this study can be summarized in two aspects.Firstly,the study aims to provide the basis clue for knowing the economic burden of six cancers and optimizing cancer prevention and control policies based on the data of the new rural cooperative medical system(NRCMS)and the household survey of cancer patients.Secondly,the study aims to construct risk prediction models for multiple cancers and six common cancers(lung cancer,stomach cancer,colorectal cancer,esophageal cancer,liver cancer,breast cancer)in Anhui,and provide a basis clue for concentrating resources to carry out cancer prevention and intervention.MethodsThe first part of the study obtained the reimbursement data of all cancer patients in different cities of Anhui province during 2013-2017 and used descriptive statistical methods to analyze data.The Community-based study on the economic burden of common cancer patients used stratified cluster sampling.Inclusion criteria are as follows: 1)cancer patients who were diagnosed as one of lung cancer,gastric cancer,colorectal cancer,esophageal cancer,liver cancer and breast cancer since 2016;2)aged 35 years and above.Structured questionnaires were used to conduct face-to-face surveys.Descriptive statistical methods were used to analyze the average case cost,direct medical cost,direct non-medical cost and indirect cost of cancer patients after diagnosis.The community-based case-control study used stratified cluster sampling.Firstly,we divided Anhui into south,middle and North according to its geographical location.Secondly,we selected 19 counties in 9 cities and 3-4 townships/streets in each county and 4-5 communities in each street/township.We included all the following cancers,such as trachea/bronchus/lung cancer,gastric cancer,colorectal cancer,esophageal cancer,liver cancer,breast cancer,cervical cancer,ovarian cancer,prostate cancer,pancreatic cancer,bladder cancer,lymphoma,kidney and other cancers of the urinary system diagnosed since 2015;We used a 1:8 case-control study.The control group were selected from the community where the cancer cases were located,who had not been diagnosed with any cancer.The matching criteria were 1:1 for men and women(except for the control group of breast cancer patients),age and case-matching.The difference in age is five years.This study used logistic regression model,improved Harvard cancer risk index and age-specific weighted index to find a relatively ideal multi-cancer and 6 single cancer risk prediction model.ResultsThe results of the study include three main parts.The first results of the study on economic burden of common cancers in NRCMS are as follows: 1)The number of reimbursements in Anhui NRCMS is 74 381 for gastric cancer,64 703 for lung cancer,46 434 for breast cancer,44 400 for colorectal cancer,25 982 for esophageal cancer and 9590 for liver cancer.The proportion of men cancer was significantly higher than women cancer,and the highest proportion was found in the 60-69 age group(40 to 49 years of breast cancer).2)The flow direction of hospitalization for the six cancers is mainly in tertiary hospitals(49% to 76%),followed by secondary hospitals(19 to 40%).There are great differences among different regions and municipalities.3)The total hospitalization expenses of every 100,000 people in rural areas of Anhui province are gastric cancer,colorectal cancer,lung cancer,esophageal cancer,breast cancer and liver cancer in turn from high to low.The highest average hospitalization expense was 23065 yuan for esophageal cancer,16872 yuan for liver cancer,12399 yuan for colorectal cancer,12471 yuan for stomach cancer and lung cancer,and 8060 yuan for breast cancer.4)The average hospitalization days in 2017 were lower than those in 2013 except for liver cancer.The average hospitalization days for six cancers in 2017 ranged from 7.4 to 15.8 days.5)The proportion of drug cost for lung cancer,gastric cancer,colorectal cancer,liver cancer and breast cancer was the highest,accounting from 20.2% to 29.9%,while the proportion of material cost for esophageal cancer was the highest,accounting for 21.9%.Compared with 2013,the drug cost proportion of five kinds of cancers decreased in 2017 except for breast cancer.The material cost of lung cancer,stomach cancer,liver cancer,colorectal cancer,esophageal cancer and breast cancer decreased.6)The average NRCMS reimbursement expenditure in the total hospitalization cost of six kinds of cancers was between 49.8% and 57.0%.The proportion of average medical expenses per time in per capita disposable income decreased from 2013 to 2017,and the proportion of personal out of pocket expenses per time in per capita disposable income showed a downward trend.However,in 2017,the proportion of average medical expenses per time in per capita disposable income for five cancers(excluding breast cancer)was from 0.92 to 1.49,and the proportion of personal out of pocket expenses per time in per capita disposable income was from 0.34 to 0.52.The second results of the study on community-based study on the economic burden of common cancer patients are as follows: 1)A total of 527 patients with cancer were investigated,including 134 cases of lung cancer,125 cases of gastric cancer,121 cases of colorectal cancer,55 cases of esophageal cancer,54 cases of liver cancer and 38 cases of breast cancer.A totle of 340 participants were male and 187 participants were female.Participants had a mean age of 62 years old.A totle of 106 urban patients and 421 rural patients were surveyed,accounting for 20.1% and 79.9% respectively.2)The average total cost of six common cancers was 287114 yuan for liver cancer,222376 yuan for esophageal cancer,206226 yuan for colorectal cancer,165947 yuan for gastric cancer,143367 yuan for lung cancer and 106367 yuan for breast cancer.The direct medical cost accounted for 61.2% of the total cost(53.1% to 69.7% for each cancer).The indirect cost accounted for 33.7% of the total cost(27.3% to 43.0% for each cancer)and the direct non-medical cost accounted for 5.1% of the total cost(3.0% to 6.3% for each cancer).3)Among the direct medical cost of cancer patients,the proportion of hospitalization expenses was highest,accounting for 74.5% to 92.9%.Outpatient expenses accounted for 2.5% to 15.7% and the expenses of self purchased drugs accounted for 0.2% to 9.8%.4)The average medical insurance reimbursement expenses per case ranged from 18316 yuan to 139457 yuan,accounting for 25.7% to 69.7% of the direct medical cost per case,and 15.7% to 48.6% of the total cost per case.The average reimbursement proportion of hospitalization expenses accounted for 28.6% to 49.6%(except for 67.7% of liver cancer)and the average reimbursement proportion of outpatient direct expenses per time was 8.0% to 19.4%(except for 61.3% of colorectal cancer).5)The total cost was higher than that of female patients,and the indirect cost of survival group was higher than that of death group.There were no significant differences in different types of expenses between male and female,death group and survival group.The average total cost of gastric cancer patients aged 70 years and over and the average total cost and hospitalization expense of patients with colorectal cancer were lower than other age groups.The average total cost and indirect cost of breast cancer patients were lowest in the highest age group(60-69 years old group).The total cost and indirect cost of patients with lung cancer and gastric cancer in rural areas were higher than those in cities.The indirect cost of patients with colorectal cancer in rural areas was higher than that in urban areas.There was no significant difference in hospitalization expense between urban and rural patients with six kinds of cancer.6)The average hospitalization expense per time of cancer patients were 26192 yuan for esophageal cancer,19124 yuan for colorectal cancer,16089 yuan for gastric cancer,15224 yuan for lung cancer,12193 yuan for breast cancer and 11639 yuan for liver cancer.The average hospitalization times ranged from 4 to 6 times and the average hospitalization days were from 8.9 to 15.4 days.7)The average outpatient medical expense per time ranged from 2206 yuan to 5475 yuan,accounting for 67.9% to 80.4% of the total outpatient expenses per time.The outpatient direct non-medical expense ranged from 175 yuan to 843 yuan,accounting for 5.9% to 13.2%,and the indirect expense ranged from 390 yuan to 1490 yuan,accounting for 6.4% to 21.2%.The average outpatient reimbursement expense ranged from 6.4% to 13.4% of the total outpatient expense.8)The proportion of hospitalization and outpatient visits of patients with different cancers decreased with the increase of the number of visits.The total hospitalization expense and the hospitalization medical expense of five cancers(except for esophageal cancer)decreased in turn from the first to the third hospitalization.No significant relationship was found between outpatient medical expense and outpatient visits.The third results of the study on community-based case-control study are as follows: 1)A total of 23701 people were investigated,including 2646 cancer patients and 21055 residents without cancer history.A total of 490 lung cancer patients.443 gastric cancer patients,406 colorectal cancer patients,338 breast cancer patients,317 esophageal cancer patients and 92 liver cancer patients accounted for 78.8% of the total cancer patients.Other cancers were 560 cases,including cervical cancer,prostate cancer,ovarian cancer,thyroid cancer,lymphoma,nasopharyngeal cancer,bladder cancer,pancreatic cancer,gallbladder cancer,kidney and other cancers.The mean age of the case group was 58.30 and the control group was 57.71.Male and Female cancer case group made up 54.7% and 45.3%,respectively.A total of 42.4% and 57.6% were male and female in control group,respectively.Urban and rural cancer patients accounted for 45.0% and 55.0% respectively in case group,while urban and rural cancer patients in control group accounted for 45.6% and 54.4% respectively.2)The risk assessment and prediction model of six common cancers in Anhui area showed good predictive effect,such as Lung cancer(AUC value is 0.765,95% CI = 0.742 to 0.787),gastric cancer(AUC 0.800,95% CI = 0.779 to 0.820),colorectal cancer(AUC 0.779,95% CI = 0.757 to 0.802),esophageal cancer(AUC 0.873,95% CI = 0.853 to 0.894),liver cancer(AUC 0.843,95% CI = 0.801 to 0.885),liver cancer(AUC 0.843,95% CI = 0.801 to 0.885).Breast cancer(AUC 0.816,95% CI = 0.791 to 0.841),multiple cancer prediction model(AUC 0.772,95% CI = 0.763 to 0.781).3)Seventeen factors were included in the lung cancer prediction model,including longtoterm residence,body mass index,rheumatoid arthritis,malaria,significant weight gain or weight loss,food reflux or acid reflux,stomach pain or stomach discomfort,longtoterm cough or sputum,family history of lung cancer,regular physical exercise,risk index of living environment,history of harmful substances exposure,risk index of life events,Monthly liquor consumption,smoking consumption,dietary preferences and daily staple food intake.4)Fourteen factors were included in the prediction model of gastric cancer,fourteen in the prediction model of colorectal cancer,ten in the prediction model of esophageal cancer,four in the prediction model of liver cancer and fifteen in the prediction model of breast cancer.5)Age and sex were used as independent weight indices in each single cancer risk prediction model.The following factors were used to construct a multiple-cancer prediction model,including the prediction index of each single cancer risk assessment model adjusted by age and sex.ConclusionThe coverage and level of reimbursement for hospitalization expenses in Anhui province for six common cancers increased significantly.The disease burden of patients reduced.The flow direction and process and cost structure of hospitalization services improved.However,there are still some problems such as regional differences.The proportion of the reimbursement cost per time to the total hospitalization cost per time of NCMS for six kinds of common cancers is relatively low.The burden of hospitalization medical expenses for different cancer patients is different,and the burden of hospitalization medical expenses for cancer patients is still very heavy.Direct medical cost are the main source of economic burden of cancer patients.The direct non-medical cost and indirect cost bring heavy economic losses,while medical insurance reimbursement cost accounts for a small proportion.The economic burden of six common cancer patients in Anhui area is still very heavy.It is necessary to further deepen the reform of major disease security system and optimize the allocation of health resources to reduce the economic burden of cancer patients.The 6 single cancer risk assessment models and multiple cancer risk assessment model established in this project show good predictive effect.The area under ROC curve is above 0.76.It is expected to provide key technologies for primary doctors to assess and identify residents with high cancer risk and concentrate health resources on key prevention interventions,so as to help reduce the economic burden and society burden of cancer patients. |
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