암 환자의 발생 초기 의료비와 이에 영향을 미치는 요인

김소영,김성경,박종혁,박은철,Kim, So-Young,Kim, Sung-Gyeong,Park, Jong-Hyock,Park, Eun-Cheol 대한예방의학회 2009 예방의학회지 Vol.42 No.4

Objectives : The purposes of this study is to estimate the cost of cancer care after its diagnosis and to identify factors that can influence the cost of cancer care. Methods : The study subjects were patients with an initial diagnosis one of four selected tumors and had their first two-years of cancer care at a national cancer center. The data were obtained from medical records and patient surveys. We classified cancer care costs into medical and nonmedical costs, and each cost was analyzed for burden type, medical service, and cancer stage according to cancer types. Factors affecting cancer care costs for the initial phase included demographic variables, socioeconomic status and clinical variables. Results : Cancer care costs for the initial year following diagnosis were higher than the costs for the following successive year after diagnosis. Lung cancer (25,648,000 won) had higher costs than the other three cancer types. Of the total costs, patent burden was more than 50% and medical costs accounted for more than 60%. Inpatient costs accounted for more than 60% of the medical costs for stomach and liver cancer in the initial phase. Care for latestage cancer was more expensive than care for early-stage cancer. Nonmedical costs were estimated to be between 4,500,000 to 6,000,000 won with expenses for the caregiver being the highest. The factors affecting cancer care costs were treatment type and cancer stage. Conclusions : The cancer care costs after diagnosis are substantial and vary by cancer site, cancer stage and treatment type. It is useful for policy makers and researchers to identify tumor-specific medical and nonmedical costs. The effort to reduce cancer costs and early detection for cancer can reduce the burden to society and improve quality of life for the cancer patients.

암환자의 생애말기 암 관련 의료비 발생 현황 분석

김혜림 ( Healim Kim ),양동욱 ( Dong-wook Yang ),강은실 ( Eunsil Kang ),김다은 ( Daeun Kim ),김진현 ( Jinhyun Kim ),배은영 ( Eun-young Bae ) 한국보건경제정책학회(구 한국보건경제학회) 2017 보건경제와 정책연구 Vol.23 No.1

본 연구는 대표성을 갖는 자료를 이용하여 암환자의 생애말기 암 관련 의료비의 최근 현황 및 양상을 파악하는 것을 목적으로 한다. 이를 위하여 국민건강보험 표본코호트 DB (2002∼2013)를 자료원으로 하여 2011년부터 2013년 사이에 사망한 암환자의 생애말기 암 관련 의료비 양상을 파악하였다. 분석결과, 사망 전 1년간 암 관련 의료비 1인당 평균은 총진료비 기준으로 연구대상자 전체(n=4,156)에서 2,156만 1천원, 암 관련 의료비 발생 집단(n=3,711)에서 2,414만 7천원이었다. 사망시점의 연령이 낮을수록, 암 유병기간이 짧을수록 생애말기 암 관련 의료비는 높게 나타났다. 사망 전 시기별 분석에서는 사망 6개월 전부터 암 관련 의료비가 증가하기 시작하여 사망 전 3개월 이내에 급격히 상승하는 것을 관찰할 수 있었다. 암 종류별로는 백혈병의 사망 전 1년간 암 관련 의료비 1인당 평균이 총진료비 기준 5,532만 6천원으로 가장 높았다. 암 관련 의료비의 4대분류별 구성비 변화를 살펴본 결과, 사망 전 10∼12개월, 7∼9개월, 4∼6개월 분기에서 약품비의 비율이 40% 내외로 유지되다 사망 전 3개월간 분기에서 28.8%로 낮아졌다. 본 연구를 통해 암환자의 생애말기 암 관련 의료비의 규모와 양상에 대한 최근 현황을 파악할 수 있었다. 이와 같은 본 연구의 분석결과는 추후 암환자를 대상으로 하는 정책수립 및 건강보험 재정계획의 근거자료로 활용될 수 있을 것으로 기대된다. Objectives : This study aims to identify the current status and aspect of end-of-life (EOL) cancer care costs. Methods : This study used a retrospective cohort data from cancer patients who died between 2011 and 2013, which were available from National Sample Cohort Data Base provided by the Korean National Health Insurance Service. The composition of EOL cancer care costs, the distribution of cancer care costs according to the characteristics of the decedent and elapsed time before death were analyzed. Results : A total of 4,156 cancer decedents were included in the study, of whom 3,711 had cancer care costs in the last one year of life. The average EOL cancer care costs were about 24.1 million won. When the age of death was low or the duration of the cancer was short, the EOL cancer care costs were high. Cancer care costs began to increase from 6 months before death and rose sharply from 3 months before death. Among the various cancer type, the EOL cancer care costs of leukemia were the highest at about 55.3 million won. The proportion of drug cost remained around 40% in the 10-12 months, 7-9months, and 4-6months before death, and the proportion of drug cost dropped to 28.8% in the remaining 3 months before death. Conclusion : The EOL cancer care costs were still high in Korea. The EOL cancer care costs varied according to the characteristics of the decedent and the time to death.

The Economic Burden of Cancer in Korea in 2009

Kim, So Young,Park, Jong-Hyock,Kang, Kyoung Hee,Hwang, Inuk,Yang, Hyung Kook,Won, Young-Joo,Seo, Hong-Gwan,Lee, Dukhyoung,Yoon, Seok-Jun Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.3

Background: Cancer imposes a significant economic burden on individuals, families and society. The purpose of this study was to estimate the economic burden of cancer using the healthcare claims and cancer registry data in Korea in 2009. Materials and Methods: The economic burden of cancer was estimated using the prevalence data where patients were identified in the Korean Central Cancer Registry. We estimated the medical, non-medical, morbidity and mortality cost due to lost productivity. Medical costs were calculated using the healthcare claims data obtained from the Korean National Health Insurance (KNHI) Corporation. Non-medical costs included the cost of transportation to visit health providers, costs associated with caregiving for cancer patients, and costs for complementary and alternative medicine (CAM). Data acquired from the Korean National Statistics Office and Ministry of Labor were used to calculate the life expectancy at the time of death, age- and gender-specific wages on average, adjusted for unemployment and labor force participation rate. Sensitivity analysis was performed to derive the current value of foregone future earnings due to premature death, discounted at 3% and 5%. Results: In 2009, estimated total economic cost of cancer amounted to $17.3 billion at a 3% discount rate. Medical care accounted for 28.3% of total costs, followed by non-medical (17.2%), morbidity (24.2%) and mortality (30.3%) costs. Conclusions: Given that the direct medical cost sharply increased over the last decade, we must strive to construct a sustainable health care system that provides better care while lowering the cost. In addition, a comprehensive cancer survivorship policy aimed at lower caregiving cost and higher rate of return to work has become more important than previously considered.

Cost Effectiveness Analysis of Different Management Strategies between Best Supportive Care and Second-line Chemotherapy for Platinum-resistant or Refractory Ovarian Cancer

Luealon, Phanida,Khempech, Nipon,Vasuratna, Apichai,Hanvoravongchai, Piya,Havanond, Piyalamporn Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.2

Background: There is no standard treatment for patients with platinum-resistant or refractory epithelial ovarian cancer. Single agent chemotherapies have evidence of more efficacy and less toxicity than combination therapy. Most are very expensive, with appreciable toxicity and minimal survival. Since it is difficult to make comparison between outcomes, economic analysis of single-agent chemotherapy regimens and best supportive care may help to make decisions about an appropriate management for the affected patients. Objective: To evaluate the cost effectiveness of second-line chemotherapy compared with best supportive care for patients with platinum-resistant or refractory epithelial ovarian cancer. Materials and Methods: A Markov model was used to estimate the effectiveness and total costs associated with treatments. The hypothetical patient population comprised women aged 55 with platinum-resistant or refractory epithelial ovarian cancer. Four types of alternative treatment options were evaluated: 1) gemcitabine followed by BSC; 2) pegylated liposomal doxorubicin (PLD) followed by BSC; 3) gemcitabine followed by topotecan; and 4) PLD followed by topotecan. Baseline comparator of alternative treatments was BSC. Time horizon of the analysis was 2 years. Health care provider perspective and 3% discount rate were used to determine the costs of medical treatment in this study. Quality-adjusted life-years (QALY) were used to measure the treatment effectiveness. Treatment effectiveness data were derived from the literature. Costs were calculated from unit cost treatment of epithelial ovarian cancer patients at various stages of disease in King Chulalongkorn Memorial Hospital (KCMH) in the year 2011. Parameter uncertainty was tested in probabilistic sensitivity analysis by using Monte Carlo simulation. One-way sensitivity analysis was used to explore each variable's impact on the uncertainty of the results. Results: Approximated life expectancy of best supportive care was 0.182 years and its total cost was 26,862 Baht. All four alternative treatments increased life expectancy. Life expectancy of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 0.510, 0.513, 0.566, and 0.570 years, respectively. The total cost of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 113,000, 124,302, 139,788 and 151,135 Baht, respectively. PLD followed by topotecan had the highest expected quality-adjusted life-years but was the most expensive of all the above strategies. The incremental cost-effectiveness ratios (ICER) of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 344,643, 385,322, 385,856, and 420,299 Baht, respectively. Conclusions: All of the second-line chemotherapy strategies showed certain benefits due to an increased life-year gained compared with best supportive care. Moreover, gemcitabine as second-line chemotherapy followed by best supportive care in progressive disease case was likely to be more effective strategy with less cost from health care provider perspective. Gemcitabine was the most cost-effective treatment among all four alternative treatments. ICER is only an economic factor. Treatment decisions should be based on the patient benefit.

호스피스 케어를 위해 입원한 말기 암 환자의 사망직전 의료비용 실태 조사

유상연,이혜리,이용제,안미홍,염창환,Yoo, Sang-Yeon,Lee, Hye-Ree,Lee, Yong-Je,Ahn, Mi-Hong,Yeom, Chang-Hwan 한국호스피스완화의료학회 2002 한국호스피스.완화의료학회지 Vol.5 No.2

배경 : 세계적으로 암의 발생률과 사망률은 증가하는 추세로, 그로 인한 의료비 상승의 문제로 국가 정책의 필요성이 대두되고 있다. 이에 저자 등은 호스피스 케어를 위해 입원한 말기 암 환자들의 의료비용 실태를 조사하고 이와 관련된 요인도 함께 살펴보아 불필요한 의료비용 부분의 효과적 감소에 도움이 되고자 하였다. 방법 : 2000년 7월 1일부터 2002년 6월 30일 사이에 경기도 고양시에 소재한 모 병원 가정의학과에 말기 암으로 입원하여 사망한 환자 259명을 대상으로 인구통계학적 자료 암의 기왕력, 임상소견, 의료비용을 조사하였다. 의료비용은 환자의 사망직전 입원 당시의 원무과 계산서를 근거로 세부 항목을 조사하였다. 인구통계학적 특성, 암의 기왕력, 임상 소견과 평균 의료비용과의 상관관계를 ANOVA로 조사하였다. 결과 : 말기 암 환자 259명중 남자가 135명(52.1%), 여자가 124명(47.9%)이었으며, 암의 종류는 위암이(58명, 22.4%) 제일 많았다. 입원 당시의 임상소견은 식욕부진이 227명(87.6%), 통증이 199명(76.8%), 오심 구토가 152명(58.7%) 순으로 높게 나타났다. 총 의료비용은 740,628,045원이었으며 환자 1인당 평균 의료비용은 $285,968{\pm}3,070,272$원이었다. 총 의료비용 중에서 주사료가 237,038,259원(32.0%)로 가장 많았고 병실료가 206,416,669원(27.9%), 검사료(임상병리 검사료와 진단 방사선료)가 103,417,747원(14.0%) 순이었다. 평균 의료비용은 주사료, 치료방사선료, 병실료 순으로 높았다. 인구통계학적 특성, 암의 기왕력, 임상소견의 항목 중 통증만 유일하게 평균 의료비용과 상관관계가 있었다(P<0.05). 결론 : 호스피스 케어를 받는 말기 암 입원 환자들에서 불필요한 마약성 진통제 등 주사 투여를 가능하면 줄이고 가정 내 호스피스를 활성화하고 과도한 검사를 줄임으로써 보다 더 효과적인 비용 절감을 도모할 수 있을 것으로 보인다. Purpose : Death due to cancer has been continuously increasing, therefore cancer is the first in the cause of death now. A national policy for the elevation of medical costs in cancer patients is necessary, therefore, we searched for the medical costs and its related factors in terminal cancer patients for the effective reduction of the medical costs. Methods : We reviewed the medical records of 259 hospitalized terminal cancer patients who had died during the period of July 1, 2000 to June 30, 2002. History of cancer included type of cancer, type of past treatment, existence of metastasis. Clinical manifestation was examined and medical costs on last admission was categorized based on the account of charges of the department of patient affair on the last hospitalization. For analysis of factors related with medical costs, ANOVA was used. Results : Of the 259 patients, the number of male was 135 cases (52.1%), and the female, 124 cases (47.9%). The most frequent type of cancer was stomach (21.9%) cancer. Of the clinical manifestation, anorexia (87.6%) was the most frequent manifestation. Total medical costs was 740,628,045won, the mean costs was $285,968{\pm}3,070,272won$. The frequent category of medical costs was injection (32.0%), medical accommodation (27.9%), examination (14.0%), in order. The only factor related with mean medical costs was pain (P<0.05). Conclusion : If unnecessary injection of opioid analgesics is reduced, hospice care at home is activated and excessive examination is reduced In terminal cancer inpatients, it will be possible to reduce the medical costs in terminal cancer patients more effectively.

Prediction in Cost of Care according to Age Group for Older People Cancer Patients in Korea: 2010-2020

Jong In Kim(김종인) 연세대학교 사회복지연구소 2011 한국사회복지조사연구 Vol.27 No.-

Background: In the formulation of national cancer care policies, accurate future predictions for the cost of care for older people cancer patients are an important element in proposing financing alternatives. The objective of the present study is to estimate of the cost of care according to age for older people cancer patients. Methods: The data from the National Health Insurance Corporation for the period 2001–2008 were used to identify 156,000 older people cancer patients and 4,178,000 older people control subjects. The estimates for the cost of care for older cancer patients in different age groups were then applied to the net increase of health care, in order to estimate the net increase of cancer care costs. Results: When the net increase of predicted average health costs per older people were the lowest for male genders in age-group 65-69 in 2010-2020, the net increase of prediction average cancer care cost per older people was the highest for both genders in this youngest age group (R-Sq(%)=95.1, P=0.002). Conclusion: The study estimates presented here form a basis for the net decrease of costs care according to the progress of aging in the older people age group for cancer patients that will be particularly important with the growing older people population. 국가 암 정복 정책에서 노인 암환자에 대한 정확한 예측은 건강보험재정의 대안들을 제안하는데 중요한 요소이다. 이러한 견지에서 연구 목적은 노인 암환자의 연령별 의료비용을 예측하고자 한다. 연구 자료는 국민건강보험관리공단의 노인환자 4백17만8천명(2001-2007)과 노인 암 환자 15만6천명(2007-2008)을 대상으로 활용하였다. 노인 암환자의 의료비용을 예측하기 위해 노인암환자와 건강보험환자의 의료비용에 대한 증가분을 비교 평가하였다. 연구결과, 2010-2020년 건강보험환자 1인당 65-69세 연령그룹의 남성의 순 의료비용 증가분이 가장 낮을 때, 동일 한 연령그룹의 암환자의 1인당 순증가분은 가장 높았다(R-Sq(%)=95.1, P=0.002). 노인환자의 의 료비용은 연령이 증가할수록 증가하지만, 노인 암환자의 의료비용은 감소한다는 사실을 발견하였다. 향후 고령사회에 대비하여 노인 암 정복 건강보험대안 입안에서 노인의 연령을 주요변수로 고려해야 할 것이다.

Prehabilitation for medically frail patients undergoing surgery for epithelial ovarian cancer: a cost- effectiveness analysis

Jhalak Dholakia,David E. Cohn,Michael Straughn, Jr,Sarah E. Dilley 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.6

Objective: To assess the potential cost-effectiveness of prehabilitation in medically frail patients undergoing surgery for epithelial ovarian cancer (EOC). Methods: We created a cost-effectiveness model evaluating the impact of prehabilitation on a cohort of medically frail women undergoing primary surgical intervention for EOC. Cost was assessed from the healthcare system perspective via (1) inpatient charges from 2018–2019 institutional Diagnostic Related Grouping data for surgeries with and without major complications; (2) nursing facility costs from published market surveys. Major complication and non-home discharge rates were estimated from the literature. Based on published pilot studies, prehabilitation was determined to decrease these rates. Incremental cost-effectiveness ratio for cost per life year saved utilized a willingness-to-pay threshold of $100,000/life year. Modeling was performed with TreeAge software. Results: In a cohort of 4,415 women, prehabilitation would cost $371.1 Million (M)versus $404.9 M for usual care, a cost saving of $33.8 M/year. Cost of care per patient with prehabilitation was $84,053; usual care was $91,713. When analyzed for cost-effectiveness, usual care was dominated by prehabilitation, indicating prehabilitation was associated with both increased effectiveness and decreased cost compared with usual care. Sensitivity analysis showed prehabilitation was more cost effective up to a cost of intervention of $9,418/patient. Conclusion: Prehabilitation appears to be a cost-saving method to decrease healthcare system costs via two improved outcomes: lower complication rates and decreased care facility requirements. It represents a novel strategy to optimize healthcare efficiency. Prospective studies should be performed to better characterize these interventions in medically frail patients with EOC.

Choosing Wisely: The Korean Perspective and Launch of the ‘Right Decision in Cancer Care’ Initiative

김주영,이경은,김규보,이명아,윤원섭,한동석,안성귀,강정훈 대한암학회 2020 Cancer Research and Treatment Vol.52 No.3

Government healthcare expenditure is rising in Korea, and the costs incurred by patients in Korea exceed those incurred by patients in other Organization for Economic Co-operation and Development countries. Despite the increasing health expenditure, patient demand for services is increasing as well, so it is now becoming recognized that cancer care needs to be balanced. The most important measure in cancer care optimization is to provide highquality care while keeping costs sustainable. The Korean Cancer Association considers the current situation of cancer therapy in Korea the foremost issue, which has led to the implementation of the nationwide ‘Right Decisions in Cancer Care’ initiative. This initiative is based on the concepts of medical professionalism in that it should be led by physicians working in the field of oncology, that education should be offered to patients and clinicians, and that it should influence healthcare policy. In this article, we introduce the nationwide ‘Right Decision in Cancer Care’ initiative and highlight the five initial items on its agenda. The agenda is open to expansion and update as the medical environment evolves and additional clinical evidence becomes available.

Development and Application of Telephone Counseling Services for Care of Patients with Colorectal Cancer

Lin, Wen-Li,Sun, Jia-Ling,Chang, Shu-Chan,Wu, Pei-Hua,Tsai, Tsung-Chih,Huang, Wen-Tsung,Tsao, Chao-Jung Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.2

Background: The number of colorectal cancer (CRC) patients in Taiwan has increased in recent years; therefore, the effective dissemination of information related to symptom care has become especially important. Previous studies indicated that the physical and psychological status of cancer patients can be effectively improved by telephone counseling services (TCS). Thus, determining the most effective means of establishing a TCS to support the clinical practice of oncology has become a crucial goal for nursing. The purposes of this study were to analysis the content of the TCS for CRC and explore stratification of the TCS. Materials and Methods: The study design was retrospective. A total of 850 calls were made to CRC patients in the cancer center of Southern Taiwan during the period of January 2007- December 2011. A structure questionnaire was adopted to analysis satisfaction. Results: Responses provided by the TCS included information regarding nutrition, side effects resulting from chemotherapy and pain. Moreover, 28.7% of CRC patients needed advanced treatment. More than 90% satisfaction with all aspects of the calls was found. Conclusions: The TCS coulkd be shown to provide an effective means by which to expand the reach of nursing care to different times, places and patients, allowing for greater cost efficiency and more rapid service.