中国肺癌患者直接医疗费用研究的系统评价
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摘要
目的系统评价中国肺癌患者的直接医疗费用研究。方法计算机检索PubMed、Scopus、TheCochrane Library、CNKI、WanFang Data和VIP数据库,搜索与中国肺癌患者医疗费用有关的研究,检索时限均为建库至2017年9月。采用Molinier等的评价工具对纳入研究的偏倚风险进行了评价,重点分析了直接医疗费用、住院费用、门诊费用的总量和结构,并探讨了不同治疗方案和疾病病程对肺癌患者直接医疗费用的影响。结果共纳入42篇文献。中国肺癌患者年人均直接医疗费用为55 295~77 431元,次均门诊费用为528~2 620元,次均住院费用为8 582~65 562元,药费在次均住院费中的占比最大(35.9%~68.4%)。肺癌患者采用不同治疗方案的直接医疗费用不同,手术患者费用多高于非手术患者,不同化疗方案的费用差异明显。结论中国肺癌患者直接医疗费用负担较重,需要进一步加强对肺癌全周期治疗费用和靶向药物治疗费用的卫生经济学研究,进一步规范费用指标的表述和分析方法。
Objectives To systematically review the direct medical cost and burden of lung cancer in Chinese population. Methods Databases such as PubMed, Scopus, CNKI, VIP and WanFang Data were searched for studies investigating cost or burden of lung cancer in Chinese population from inception to September, 2017. Based on inclusion and exclusion criteria, two researchers screened literature, extracted data, and assessed methodological quality of included studies according to methods from Molinier, LA. Descriptive analysis was used to analyze the direct medical cost inconjunction with its composition and other aspects including various costs of different therapeutic regimens and temporal trends. Results A total of 42 studies were included. The direct medical cost per person per year varied from 55 295 yuanto 77 431 yuan. In addition, the direct medical cost for hospitalization ranged from 8 582 yuan to 65 562 yuan. The cost ofdrug accounted for the largest part. Costs showed differences in diverse treatment regimens and time periods.Conclusions High quality studies on direct medical cost of lung cancer in China are rare. The direct medical burden of lung cancer in China is seriously high. As a consequence, control work is urgently required. Numerous factors including sample size, region, methods for dealing with data and value sets could influence the measurement results of cost. Future research could set focus on analysis based on time dimension, cost of target drug as well as the adverse effects caused bymedication.
Objectives To systematically review the direct medical cost and burden of lung cancer in Chinese population. Methods Databases such as PubMed, Scopus, CNKI, VIP and WanFang Data were searched for studies investigating cost or burden of lung cancer in Chinese population from inception to September, 2017. Based on inclusion and exclusion criteria, two researchers screened literature, extracted data, and assessed methodological quality of included studies according to methods from Molinier, LA. Descriptive analysis was used to analyze the direct medical cost inconjunction with its composition and other aspects including various costs of different therapeutic regimens and temporal trends. Results A total of 42 studies were included. The direct medical cost per person per year varied from 55 295 yuanto 77 431 yuan. In addition, the direct medical cost for hospitalization ranged from 8 582 yuan to 65 562 yuan. The cost ofdrug accounted for the largest part. Costs showed differences in diverse treatment regimens and time periods.Conclusions High quality studies on direct medical cost of lung cancer in China are rare. The direct medical burden of lung cancer in China is seriously high. As a consequence, control work is urgently required. Numerous factors including sample size, region, methods for dealing with data and value sets could influence the measurement results of cost. Future research could set focus on analysis based on time dimension, cost of target drug as well as the adverse effects caused bymedication.
引文
1 Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2):69-90.
2 Chen W, Zheng R, Baade PD, et al. Cancer statistics in China,2015. CA Cancer J Clin, 2016, 66(2):115-132.
3 Karve SJ, Price GL, Davis KL, et al. Comparison of demographics,treatment patterns, health care utilization, and costs among elderly patients with extensive-stage small cell and metastatic non-smallcell lung cancers. BMC Health Services Research,2014,14(1):555.
4 Xue C, Hu Z, Jiang W, et al. National survey of the medical treatment status for non-small cell lung cancer(NSCLC)in China.Lung Cancer, 2012, 77(2):371-375.
5吴一龙,程颖,周清,等.中国临床肿瘤学会(CSCO)原发性肺癌诊疗指南(2017.V1).北京:人民卫生出版社,2017:26-81.
6 Thongprasert S, Permsuwan U. Crizotinib treatment for advanced non-small-cell lung cancer patients:a budget impact analysis based in Thailand. Curr Med Res Opin, 2017, 33(5):955-961.
7 Warren JL, Yabroff KR, Meekins A, et al. Evaluation of trends in the cost of initial cancer treatment. J Natl Cancer Inst, 2008,100(12):888-897.
8 Molinier L, Combescure C, Chouaid C, et al. Cost of lung cancer:a methodological review. Pharmacoeconomics, 2006, 24(7):651-659.
9刘宝.4种非小细胞肺癌二线药物治疗方案费用比较研究.中国药房,2010, 21(26):2403-2406.
10高月霞,肖静,吴徐明,等.1666例肺癌患者直接住院费用构成的因子分析.中国卫生统计,2011,28(3):278-280.
11鲍晓蕾,胡良平,陈韬,等.甘肃省2778例肺癌患者住院费用影响因素分析.军事医学,2015, 39(11):838-841.
12缪艳瑶,胡欣.某肿瘤专科医院2011~2013年肺癌患者住院费用分析.医学信息,2015, 28(43):131-132.
13吕红亮,赵少峰,谢小萍,等.四川省16866例肺癌患者住院费用影响因素分析.中国循证医学杂志,2013, 13(11):1283-1287.
14王亭艳,欧阳静.新疆某医院肺癌患者医疗负担及发展趋势研究.医学与社会,2017, 30(5):20-22.
15卢永吉,胡晓斌,寇嘉宁,等.兰州市1996~2006年肺癌患者住院费用趋势分析.现代预防医学,2010, 37(9):1674-1676.
16张云兵,肖梦,李韶霞,等.10年间山西某综合医院肺癌患者住院费用影响因素分析.卫生软科学,2016, 30(10):31-35.
17陈丽,冯华,程卫华,等.非小细胞肺癌晚期患者医疗费用分析.武警医学,2011,22(11):976-978.
18张文,王永林,刘宝枚,等.肺癌化疗患者住院费用调查分析.中国医药,2016, 11(8):1153-1156.
19李亚运,钱东福,周守君,等.某地区肺癌住院患者直接经济负担城乡差异比较研究.重庆医学,2016, 45(5):661-663.
20黄海红,冯运,金永春,等.上海某三级专科医院住院肺癌患者经济负担研究.中国医院管理,2012, 32(2):57-59.
21王梅,王媛媛,郭斌,等.我国肺癌疾病的直接住院费用负担现状及其问题.中国卫生经济,2007, 26(6):59-62.
22马蔚姝.肺癌患者医疗保险费用影响因素的分析.中国城乡企业卫生,2016,(3):6-7.
23赵少峰,吕红亮,彭映姝,等.肺癌患者住院费用影响因素分析—以四川省某三甲医院为例.预防医学情报杂志,2014, 30(5):342-345.
24 Zhou LF, Zhang MX, Kong LQ, et al. Costs, trends, and related factors in treating lung cancer patients in 67 hospitals in Guangxi,China. Cancer Invest, 2017, 35(5):345.
25孙翠勇.肺癌患者住院费用构成的因子分析.重庆医学,2015,44(28):4005-4007.
26徐张燕,周守君,季花,等.某三级肿瘤专科医院肺癌住院医药费用与影响因素分析.中国肿瘤,2015, 24(11):915-918.
27常雁军,陈宗敏.医保与自费肺癌病人化疗费用比较.中国医院管理学术年会,2011.
28周彩虹,张力建,熊洪超,等.肿瘤专科医院肺癌住院费用及相关因素的回顾调查分析.中国医院管理,2010, 30(7):37-40.
29武兴龙,饶江红,康云霞.南昌市肺癌患者疾病经济负担调查.环境卫生学杂志,2015, 5(6):507-511.
30丁婷婷,张晓,高翠,等.非小细胞肺癌患者住院费用影响因素分析及控费研究.中国卫生统计,2012, 29(2):240-242.
31王翠娟,尚明,佟峰.山东省肺癌住院患者直接经济负担影响因素分析.中国医院统计,2016, 23(4):254-257.
32杜巍,张晓,高翠,等.600例非小细胞肺癌患者住院费用的新灰色关联分析.上海交通大学学报(医学版),2012, 32(10):1356.
33麻新梅,张云莲.1192例肺癌患者住院情况分析.中国医药指南,2007,(6):86-87.
34刘媛,陶路宁,金永春.肺癌患者胸腔镜与开放手术住院费用分析.中国病案,2017, 18(3):65-68.
35 Wang BY, Huang JY, Ko JL, et al. A population-based cost analysis of thoracoscopic versus open lobectomy in primary lung cancer.Ann Surg Oncol, 2016, 23(6):2094-2098.
36路庆,韩晓梅,郭志金,等.肺癌手术患者住院费用影响因素分析.中国医院统计,2012, 19(3):203-206.
37刘欢,于智新,刘曦惟,等.肺癌手术患者住院费用及影响因素分析.中国卫生经济,2016, 35(7):77-79.
38陈宗祥.近万例肺癌病人住院手术费用结构及趋势分析.中国卫生资源,2013, 16(3):202-204.
39 Shi J, Zhu J. Health resource utilization in patients with advanced non-small cell lung cancer receiving chemotherapy in China. Clin Drug Investig,2016, 36(1):77-86.
40 Chen W, Lin Y, Zhang L. Access to innovation and economic burden-a case of non-small cell lung cancer in a patient access program in Qingdao, China. Value Health, 2015, 18(7):A492-A492.
41肖海帆,廖先珍,许可葵,等.2002~2014年1542例肺癌患者住院费用分析.中国肿瘤,2016, 25(5):338-344.
42彭红,黄艾弥,陶路宁,等.2000~2009年肺癌患者临床特征变化和直接医疗费用分析.中国肿瘤,2013, 22(8):666-670.
43彭红,许汝言,叶露,等.上海市肺癌患者疾病经济负担研究.中国卫生经济,2015, 34(8):78-81.
44 Zhang X, Liu S, Liu Y, et al. Economic burden for lung cancer survivors in urban China. Int J Environ Res Public Health, 2017,14(3):308.
45 Li B, Li MY, Sun LL, et al. Impact of anticancer drugs price cut on physician's prescription choices on first-line chemotherapy regimens and health expenditure for advanced non-small cell lung cancer in China. J Thorac Dis, 2016, 8(10):2832-2842.
46 Chen J, Wu S, Hu C, et al. Real-world hospital costs for nonchemotherapy drugs and nondrug care associated with platinum-based doublets in the first-line setting for advanced nonsquamous non-small-cell lung cancer in Chinese patients:a retrospective cohort study. Clinicoecon Outcomes Res, 2016, 8(1):97-111.
47 Chen YM, Perng RP, Shih JF, et al. Salvage therapy for Chinese non-small cell lung cancer patients who failed previous chemotherapy. J Thorac Oncol, 2006, 1(6):545-550.
48 Zeng X, Karnon J, Wang S, et al. The cost of treating advanced non-small cell lung cancer:estimates from the Chinese Experience.PLOS One, 2012, 7(10):e48323.
49 Li X, Wang Y, Wang Y, et al. Supportive care costs associated with second-line chemotherapy in Chinese patients with advanced nonsquamous non-small cell lung cancer:a retrospective cohort study.Drugs Real World Outcomes, 2015, 2(1):87-97.
50董佩,毛阿燕,邱五七,等.北京市本地与外地肺癌患者就诊及医疗费用分析.中国病案,2017,18(1):47-50.
51 Demeter, S J, Jacobs P, Chmielowiec C, et al. The cost of lung cancer in Alberta. Can Respir J, 2007,14(2):81-86.
52 Schwarzkopf L, Wacker M, Holle R, et al. Cost-components of lung cancer care within the first three years after initial diagnosis in context of different treatment regimens. Lung Cancer, 2015, 90(2):274-280.
53 Mahar AL, Fong R, Johnson A. PCN36 the economic impact of treating early lung cancer:a systematic review. Value Health, 2011,14(7):A440-A440.
54 Solem CT, Penrod JR, Lees M, et al. Cost drivers of lung cancer care:results from a retrospective chart review of pretreated advanced NSCLC patients in Europe. Value Health, 2017, 20(9):A431-A432.
2 Chen W, Zheng R, Baade PD, et al. Cancer statistics in China,2015. CA Cancer J Clin, 2016, 66(2):115-132.
3 Karve SJ, Price GL, Davis KL, et al. Comparison of demographics,treatment patterns, health care utilization, and costs among elderly patients with extensive-stage small cell and metastatic non-smallcell lung cancers. BMC Health Services Research,2014,14(1):555.
4 Xue C, Hu Z, Jiang W, et al. National survey of the medical treatment status for non-small cell lung cancer(NSCLC)in China.Lung Cancer, 2012, 77(2):371-375.
5吴一龙,程颖,周清,等.中国临床肿瘤学会(CSCO)原发性肺癌诊疗指南(2017.V1).北京:人民卫生出版社,2017:26-81.
6 Thongprasert S, Permsuwan U. Crizotinib treatment for advanced non-small-cell lung cancer patients:a budget impact analysis based in Thailand. Curr Med Res Opin, 2017, 33(5):955-961.
7 Warren JL, Yabroff KR, Meekins A, et al. Evaluation of trends in the cost of initial cancer treatment. J Natl Cancer Inst, 2008,100(12):888-897.
8 Molinier L, Combescure C, Chouaid C, et al. Cost of lung cancer:a methodological review. Pharmacoeconomics, 2006, 24(7):651-659.
9刘宝.4种非小细胞肺癌二线药物治疗方案费用比较研究.中国药房,2010, 21(26):2403-2406.
10高月霞,肖静,吴徐明,等.1666例肺癌患者直接住院费用构成的因子分析.中国卫生统计,2011,28(3):278-280.
11鲍晓蕾,胡良平,陈韬,等.甘肃省2778例肺癌患者住院费用影响因素分析.军事医学,2015, 39(11):838-841.
12缪艳瑶,胡欣.某肿瘤专科医院2011~2013年肺癌患者住院费用分析.医学信息,2015, 28(43):131-132.
13吕红亮,赵少峰,谢小萍,等.四川省16866例肺癌患者住院费用影响因素分析.中国循证医学杂志,2013, 13(11):1283-1287.
14王亭艳,欧阳静.新疆某医院肺癌患者医疗负担及发展趋势研究.医学与社会,2017, 30(5):20-22.
15卢永吉,胡晓斌,寇嘉宁,等.兰州市1996~2006年肺癌患者住院费用趋势分析.现代预防医学,2010, 37(9):1674-1676.
16张云兵,肖梦,李韶霞,等.10年间山西某综合医院肺癌患者住院费用影响因素分析.卫生软科学,2016, 30(10):31-35.
17陈丽,冯华,程卫华,等.非小细胞肺癌晚期患者医疗费用分析.武警医学,2011,22(11):976-978.
18张文,王永林,刘宝枚,等.肺癌化疗患者住院费用调查分析.中国医药,2016, 11(8):1153-1156.
19李亚运,钱东福,周守君,等.某地区肺癌住院患者直接经济负担城乡差异比较研究.重庆医学,2016, 45(5):661-663.
20黄海红,冯运,金永春,等.上海某三级专科医院住院肺癌患者经济负担研究.中国医院管理,2012, 32(2):57-59.
21王梅,王媛媛,郭斌,等.我国肺癌疾病的直接住院费用负担现状及其问题.中国卫生经济,2007, 26(6):59-62.
22马蔚姝.肺癌患者医疗保险费用影响因素的分析.中国城乡企业卫生,2016,(3):6-7.
23赵少峰,吕红亮,彭映姝,等.肺癌患者住院费用影响因素分析—以四川省某三甲医院为例.预防医学情报杂志,2014, 30(5):342-345.
24 Zhou LF, Zhang MX, Kong LQ, et al. Costs, trends, and related factors in treating lung cancer patients in 67 hospitals in Guangxi,China. Cancer Invest, 2017, 35(5):345.
25孙翠勇.肺癌患者住院费用构成的因子分析.重庆医学,2015,44(28):4005-4007.
26徐张燕,周守君,季花,等.某三级肿瘤专科医院肺癌住院医药费用与影响因素分析.中国肿瘤,2015, 24(11):915-918.
27常雁军,陈宗敏.医保与自费肺癌病人化疗费用比较.中国医院管理学术年会,2011.
28周彩虹,张力建,熊洪超,等.肿瘤专科医院肺癌住院费用及相关因素的回顾调查分析.中国医院管理,2010, 30(7):37-40.
29武兴龙,饶江红,康云霞.南昌市肺癌患者疾病经济负担调查.环境卫生学杂志,2015, 5(6):507-511.
30丁婷婷,张晓,高翠,等.非小细胞肺癌患者住院费用影响因素分析及控费研究.中国卫生统计,2012, 29(2):240-242.
31王翠娟,尚明,佟峰.山东省肺癌住院患者直接经济负担影响因素分析.中国医院统计,2016, 23(4):254-257.
32杜巍,张晓,高翠,等.600例非小细胞肺癌患者住院费用的新灰色关联分析.上海交通大学学报(医学版),2012, 32(10):1356.
33麻新梅,张云莲.1192例肺癌患者住院情况分析.中国医药指南,2007,(6):86-87.
34刘媛,陶路宁,金永春.肺癌患者胸腔镜与开放手术住院费用分析.中国病案,2017, 18(3):65-68.
35 Wang BY, Huang JY, Ko JL, et al. A population-based cost analysis of thoracoscopic versus open lobectomy in primary lung cancer.Ann Surg Oncol, 2016, 23(6):2094-2098.
36路庆,韩晓梅,郭志金,等.肺癌手术患者住院费用影响因素分析.中国医院统计,2012, 19(3):203-206.
37刘欢,于智新,刘曦惟,等.肺癌手术患者住院费用及影响因素分析.中国卫生经济,2016, 35(7):77-79.
38陈宗祥.近万例肺癌病人住院手术费用结构及趋势分析.中国卫生资源,2013, 16(3):202-204.
39 Shi J, Zhu J. Health resource utilization in patients with advanced non-small cell lung cancer receiving chemotherapy in China. Clin Drug Investig,2016, 36(1):77-86.
40 Chen W, Lin Y, Zhang L. Access to innovation and economic burden-a case of non-small cell lung cancer in a patient access program in Qingdao, China. Value Health, 2015, 18(7):A492-A492.
41肖海帆,廖先珍,许可葵,等.2002~2014年1542例肺癌患者住院费用分析.中国肿瘤,2016, 25(5):338-344.
42彭红,黄艾弥,陶路宁,等.2000~2009年肺癌患者临床特征变化和直接医疗费用分析.中国肿瘤,2013, 22(8):666-670.
43彭红,许汝言,叶露,等.上海市肺癌患者疾病经济负担研究.中国卫生经济,2015, 34(8):78-81.
44 Zhang X, Liu S, Liu Y, et al. Economic burden for lung cancer survivors in urban China. Int J Environ Res Public Health, 2017,14(3):308.
45 Li B, Li MY, Sun LL, et al. Impact of anticancer drugs price cut on physician's prescription choices on first-line chemotherapy regimens and health expenditure for advanced non-small cell lung cancer in China. J Thorac Dis, 2016, 8(10):2832-2842.
46 Chen J, Wu S, Hu C, et al. Real-world hospital costs for nonchemotherapy drugs and nondrug care associated with platinum-based doublets in the first-line setting for advanced nonsquamous non-small-cell lung cancer in Chinese patients:a retrospective cohort study. Clinicoecon Outcomes Res, 2016, 8(1):97-111.
47 Chen YM, Perng RP, Shih JF, et al. Salvage therapy for Chinese non-small cell lung cancer patients who failed previous chemotherapy. J Thorac Oncol, 2006, 1(6):545-550.
48 Zeng X, Karnon J, Wang S, et al. The cost of treating advanced non-small cell lung cancer:estimates from the Chinese Experience.PLOS One, 2012, 7(10):e48323.
49 Li X, Wang Y, Wang Y, et al. Supportive care costs associated with second-line chemotherapy in Chinese patients with advanced nonsquamous non-small cell lung cancer:a retrospective cohort study.Drugs Real World Outcomes, 2015, 2(1):87-97.
50董佩,毛阿燕,邱五七,等.北京市本地与外地肺癌患者就诊及医疗费用分析.中国病案,2017,18(1):47-50.
51 Demeter, S J, Jacobs P, Chmielowiec C, et al. The cost of lung cancer in Alberta. Can Respir J, 2007,14(2):81-86.
52 Schwarzkopf L, Wacker M, Holle R, et al. Cost-components of lung cancer care within the first three years after initial diagnosis in context of different treatment regimens. Lung Cancer, 2015, 90(2):274-280.
53 Mahar AL, Fong R, Johnson A. PCN36 the economic impact of treating early lung cancer:a systematic review. Value Health, 2011,14(7):A440-A440.
54 Solem CT, Penrod JR, Lees M, et al. Cost drivers of lung cancer care:results from a retrospective chart review of pretreated advanced NSCLC patients in Europe. Value Health, 2017, 20(9):A431-A432.
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