Unbalanced Treatment Costs of Breast Cancer in China: Implications From the Direct Costs of Inpatient and Outpatient Care in Liaoning Province

Background  The increasing incidence of breast cancer and its financial burden highlights the need for controlling treatment costs. This study aimed to assess the direct costs of inpatient and outpatient care for breast cancer patients in Liaoning Province to provide a policy reference for cost containment. Methods  Based on the System of Health Accounts ۲۰۱۱ (SHA ۲۰۱۱), systematic data collection was conducted via multistage stratified cluster random sampling. A total of ۱۱۶۰ health institutions, including ۸۳ hospitals, ۱۶ public health institutions, ۱۲۰ primary health institutions, and ۹۴۱ outpatient institutions were enrolled in ۲۰۱۷. A database was established containing ۲۰ ۰۳۵ patient-level medical records from the information system of these institutions. Curative care expenditure (CCE)was calculated, and generalized linear modeling was performed to determine cost-related factors. Results  In ۲۰۱۷, the CCE for breast cancer was approximately CNY ۸۳۰.۱۹ million (US۱۲۲.۹۶ million) in Liaoning province (۰.۷% of the total health expenditure and ۹.۹% of cancer- related healthcare costs). Inpatient care costs were estimated to be CNY ۶۱۷.۲۷ million (US۹۱.۴۲ million), accounting for ۷۴.۴% of the CCE for breast cancer, almost three times as large as outpatient costs (۲۵.۶%). The average inpatient and outpatient costs for breast cancer were estimated to be CNY ۱۲ ۱۰۸ (US۱۷۹۳) and CNY ۸۲۹ (US۱۲۳) per visit. Medication cost was the main cost driver, which comprised ۸۴.۰% of the average outpatient cost and ۳۷.۲% of the mean inpatient cost. Conclusion  Breast cancer imposes a large economic burden on patients and the social health insurance system. Results show an irrational cost pattern of inpatient and outpatient services, with patients relying excessively on inpatient services for treatment. Promoting outpatient care whenever relevant is conducive to cost containment and rational utilization of resources.

Keywords:

Breast Cancer , Healthcare Expenditure , Medical Service Utilization , Cost Containment , China