背景:癌症的全球经济成本和幸存者持续护理的成本正在增加。对于越来越多的癌症幸存者,影响住院治疗和相关费用的因素知之甚少。我们的目的是从卫生服务的角度确定公共系统中癌症幸存者入院的相关因素及其成本。
方法:以人口为基础,回顾性,数据连锁研究在昆士兰州进行(COS-Q),澳大利亚,包括在2013年至2016年期间发生医疗保健费用的被诊断患有第一原发癌的个人。拟合了广义线性模型,以探索社会人口统计学(年龄,性别,出生国,婚姻状况,职业,地理偏远类别和社会经济指数)和临床(癌症类型,自诊断以来的年份/时间,生命状态和护理类型)具有平均年住院费用和平均发作费用的因素。
结果:队列(N=230,380)中,48.5%(n=111,820)在公共系统中住院(n=682,483例入院)。住院费用最高的是在费用期间死亡的个人(费用比'CR':1.79,p<0.001)或居住在非常偏远或偏远的地方(CR:1.71和CR:1.36,p<0.001)或0-24岁(CR:1.63,p<0.001)。在康复或姑息治疗中,发作费用最高(CR:2.94和CR:2.34,p<0.001),或非常偏远的位置(CR:2.10,p<0.001)。总体医院费用的较高贡献者是“消化系统疾病和疾病”(6.61亿澳元,21%的入院)和“肿瘤性疾病”(5.54亿澳元,20%的招生)。
结论:我们确定了一系列与癌症幸存者住院和更高住院费用相关的因素。我们的结果清楚地表明,住院的公共卫生成本非常高。缺乏在短期或中期内降低这些成本的明显手段,这强调了改善癌症预防和投资于家庭或社区患者支持服务的经济必要性。
BACKGROUND: The global economic cost of cancer and the costs of ongoing care for survivors are increasing. Little is known about factors affecting hospitalisations and related costs for the growing number of cancer survivors. Our aim was to identify associated factors of cancer survivors admitted to hospital in the public system and their costs from a health services perspective.
METHODS: A population-based, retrospective, data linkage study was conducted in Queensland (COS-Q), Australia, including individuals diagnosed with a first primary cancer who incurred healthcare costs between 2013 and 2016. Generalised linear models were fitted to explore associations between socio-demographic (age, sex, country of birth, marital status, occupation, geographic remoteness category and socio-economic index) and clinical (cancer type, year of/time since diagnosis, vital status and care type) factors with mean annual hospital costs and mean episode costs.
RESULTS: Of the cohort (N = 230,380) 48.5% (n = 111,820) incurred hospitalisations in the public system (n = 682,483 admissions). Hospital costs were highest for individuals who died during the costing period (cost ratio \'CR\': 1.79, p < 0.001) or living in very remote or remote location (CR: 1.71 and CR: 1.36, p < 0.001) or aged 0-24 years (CR: 1.63, p < 0.001). Episode costs were highest for individuals in rehabilitation or palliative care (CR: 2.94 and CR: 2.34, p < 0.001), or very remote location (CR: 2.10, p < 0.001). Higher contributors to overall hospital costs were \'diseases and disorders of the digestive system\' (AU$661 m, 21% of admissions) and \'neoplastic disorders\' (AU$554 m, 20% of admissions).
CONCLUSIONS: We identified a range of factors associated with hospitalisation and higher hospital costs for cancer survivors, and our results clearly demonstrate very high public health costs of hospitalisation. There is a lack of obvious means to reduce these costs in the short or medium term which emphasises an increasing economic imperative to improving cancer prevention and investments in home- or community-based patient support services.