| Background? ?Oral cancer has been recognized as a huge threat to public health because of its high morbidity and mortality. It is estimated that each year there are over 484,000 people diagnosed with oral cancer in the world and approximately 261,000 people die of this disease. About 2/3 OC patients were diagnosed in developing country. In China, over 11,900 cases of oral cancers are diagnosed each year and approximately 5,000 patients die of this disease. But there were few studies about the disease in China. Smoking, alcohol, HPV, and diet etc. are the main influencing factors of the disease. With the development of medical insurance reform, the total costs of singal disease had been paid more and more attention by doctor, patient and medical insurance administration. It is an important research subject to balance the benefit of the three parts. How to protect patients’benefit, control the medical costs and utilize the medical resource properly has always a crucial item. With the increase of OC patients, the costs for treating the disastrous disease also increased. Researchers have paid more and more attention on analyzing the costs of OC paients. Although several studies have reported the direct cost of OC, little research has investigated the factors that could influence the costs of OC. So, it is necessary to study the relation between the cost and the factors that could influence the costs of OC such as gender, age, pathology, stage, somking and so on. Our research could not only supply epidemical information but also be very important for the medical economics of OC.This study analyzes the epidemiological characteristics and the direct cost of oral cancer. More specifically, the study examines the relationship between patients’medical costs and influencing factors of epidemiology.Patients?and?Methods? ?All patients encountered from January 2007 to December 2007 at the School of Stomatology of the Fourth Military Medical University (FMMU) in China with diagnosis of oral cancer have been selected. The details were as following steps:①Patients were selected from HIS with the condition of indentified department, ICD codes and the admission time.②A computer programe was used to select and calculate all of the inpatients information including every kinds of costs by the patients’ID.③The patients’electronic medical record were selected from the database by another program.④The patients’information about pathology, somking habits and stages etc were picked up from the electronic medical record.⑤The patients’information were processed by unifying the pathology, urban and rural and abandon of treatment.⑥The datas with unclear information or error were deleted. (Epidemiological study included the patients who were diagnosed as having malignancies of the oral cavity. Cost analysis study included those who had received at least one of the following treatments: surgery, chemotherapy and radiotherapy. Patients who gave up treatment or who chose to receive treatment in other hospitals were not included in the cost analysis study.)⑦Data for epidemiological study included age, gender, pathology, clinical stage, and smoking habits. Data for cost analysis included the cost for diagnosing, treatment, and hospitalization.⑧Continuous variables are presented with mean and standard deviation, while discrete variables are presented with absolute and relative frequencies. Chi-square tests were used for the comparisons of proportions. Student’s t-tests were computed for the comparison of mean values. Differences on CPP(cost per patient) and MHD(medical hospital days) according pathology were determined by analysis of variance(ANOVA). The differences on the costs of diagnose, treatment and inpatient according pathology were also determined by ANOVA. Risk factors for squamous cell carcinoma (SCC) were determined by analysis of logistic regression while the variables for CPP were determined by multiple liner regression. Adjusted odds ratios with 95% confidence intervals were computed from the results of the logistic regression analyses. All p-values reported are two-tailed. Statistical significance was set at 0.05 and SPSS 17.0 was employed to perform all of the analyses.?Result?During the period of 2007, Stomatology Hospital of the FMMU received a total of 456 new patients (176 females, 280 males) that had been previously diagnosed with oral cancer. The pathologies of this group of samples included squamous SCC, lymphoma, adenocarcinoma, sarcoma and others. Cytoma, small cell carcinoma, melanoma and clear-cell carcinoma were put into“others”category for their rarity. Of the 456 oral cancer patients, 53.9% (246/456) were SCC; 27.85% (127/456) were adenocarcinoma; 8.77% (40/456) were sarcoma; and 5.92% (27/456) were lymphoma. According to the TNM stage (WHO for Staging Oral Cancer), 32.46% (148/456) were diagnosed at stage II, 25.21% (115/456) at stage IV, 22.59% (103/456) at stage III and 19.74% (90/456) at stage I. 29.82%(136/456) patient had smoking habit while 132 were male and 4 were female(table 1). Of the 136 smoking patients, 69.85% (95/136) got SCC, 17.65% (24/136) got adenocarcinoma, and 12.50% had other pathology types such as lymphoma, sarcoma. Epidemiology?①The proportion of smoking patients in SCC was higher than that of adenocarcinoma.②The proportion of smoking patients in late stage was higher than that of early stage.③In all the sample, the proportion of male in late stage was higher than that of female, but there was no difference between them in the non-somking sample.④The mean age of the whole sample was 54.63±16.73, while the mean age of female was 54.08±16.26 and that of male was 55.06±17.15. There was no evident difference between them.⑤The mean age of patient came from rural was 48.56±16.79, whle the mean age of urban patiens was 55.94±16.54. The mean age of rural patients was smaller than that of urban patiens.⑥The mean age of SCC patients was higher than the other patients.⑦The mean age of sarcoma patiens was smaller than that of other patients.⑧There were 82% patients whose age were older than 40.⑨Smoking and older age were the influencing factors of OC. Patients with smoking habit had 3.032 times greater odds (95%CI: 1.565-5.872) for SCC than non-smoking patients. The odds for SCC were 3.231 times higher for patients older than 40 compared with patients younger than 40 years old.Costs?analysis?Of the all the patients selected to this study, 372 patients had received at least one of the three treatments, surgery, radiation and chemotherapy, and 84 patients chose not to receive any treatment in this hospital. 89.20% of those who received treatments in this hospital did not have medicare (332/372); only 10.80% of them (40/372) were covered with medicare.①The CPP of male was higher than that of female, but there was no difference between them with MHD. There were no difference between male and female with the costs of diagnose and hospitalization while the treatment cost of male was higher than female.②The CPP and MHD of somking group were higher than the non-smoking group while there were no differences between the male non-smoking group and female group. The treatment and hospitalization costs of smoking group were higher than that of non-smoking group while there was no difference between them with the costs of diagnose.③There was no difference between patients with and without medicare in MHD, but the CPP of patient with medicare was lower than that of without medicare. There was no difference between patients with and without medicare in the costs of hospitalization, but the costs of diagnosis and treatment of patients without medicare were higher than patients with medicare.④There were no difference between patients came from rural and urban. And there were still no difference between the two groups in the costs of diagnosis, treatment and hospitalization.⑤There were no difference between older and younger groups in both MHD and CPP.⑥The CPP and MHD of late stage group were higher than that of early stage group and the costs of diagnose, treatment and hospitalization of late stage were higher than those of early stage.⑦The CPP and MHD of patients with adenocarcinoma were lower than those of patients with SCC and sarcoma.⑧Late stage, SCC and without medicare were the influencing factors of high costs of OC patients.Conclusion? ?①Smoking habit and age older than 40 years are the epidemiological risk factors for oral cancer.②Dentist should pay more attention to the male patients who are older than 40 and have smoking habit for these patient were high risk population of OC.③Lack of medicare, late clinical stage and SCC were the derect influencing factors for patient medical cost. Smoking habit was the indirect influencing factors for high costs of OC patient.④Smoking banning would reduce the economic pressure which was caused by OC to both family and society. |
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