Analysis of cost of illness and diagnosis-related group payment system in breast cancer patients with chemotherapy in Indonesia
DOI:
https://doi.org/10.46542/pe.2024.243.147152Keywords:
Breast cancer, Cost, Cost of illness, Diagnosis-related payment, Economic burdenAbstract
Background: Often, breast cancer patients undergoing chemotherapy sacrifice their finances, and the financial costs also affect the government.
Objective: This study aims to analyse the cost of illness and the application of an insurance payment system among breast cancer patients receiving various chemotherapy regimens.
Method: This study was retrospective and used a bottom-up prevalence approach. Data were collected from a secondary hospital between 2020 and 2021. The inclusion criteria were breast cancer patients undergoing chemotherapy. Patients with incomplete detailed cost data were excluded. The cost of illness was calculated from direct medical costs and the estimated non-medical and indirect costs.
Results: The cost of illness for a chemotherapy visit for a breast cancer patient spanned from USD 130.37 to USD 932.05. However, these values did not include healthcare service costs and laboratory tests. The highest regimentation chemotherapy cost is for the combination of docetaxel–cyclophosphamide–trastuzumab. There was a significant margin between insurance claims and variable medical costs (p < 0,05), ranging between USD 24.21 and 104.83.
Conclusion: The cost of illness for chemotherapy for breast cancer patients is high, and the coverage of the diagnosis-related payment system is limited. Therefore, the government should accelerate prevention programmes to reduce the incidence of cancer.
References
Carrera, P. M., Kantarjian, H. M., & Blinder, V. S. (2018). The financial burden and distress of patients with cancer: Understanding and stepping-up action on the financial toxicity of cancer treatment. CA: A Cancer Journal for Clinicians, 68(2), 153–165. https://doi.org/10.3322/caac.21443
Carrera, P. M., Kantarjian, H. M., & Blinder, V. S. (2019). The Financial burden and distress of patients with cancer: Understanding and stepping-up action on the financial toxicity of cancer teatment. Physiology & Behavior, 176(1), 100–106. https://doi.org/10.3322/caac.21443
Dhanushkodi, M., Sridevi, V., Shanta, V., Rama, R., Swaminathan, R., Selvaluxmy, G., & Ganesan, T. S. (2021). Locally Advanced Breast Cancer (LABC): Real-world outcome of patients from cancer institute, Chennai. JCO Global Oncology, 7, 767–781. https://doi.org/10.1200/go.21.00001
East Java Government. (2021). East Java Governor's decision number 108/538/KPtS/013/2020 regarding district minimum wages in 2021. https://lamongankab.go.id/beranda/documents/disnaker/UMK JAWA TIMUR TAHUN 2021.pdf
Gao, H., Li, Q., Wei, W., Jiang, Y., Yang, H., & Liu, J. (2015). Efficacy of vinorelbine-based neoadjuvant chemotherapy in breast cancer: A systematic review and meta-analysis of randomized controlled trials. Molecular and Clinical Oncology, 3(5), 1145–1151. https://doi.org/10.3892/mco.2015.576
Gunn, A. H., Sorenson, C., & Greenup, R. A. (2021). Navigating the high costs of cancer care: Opportunities for patient engagement. Future Oncology, 17(28), 3729–3742. https://doi.org/10.2217/fon-2021-0341
Lawal, A. K., Groot, G., Goodridge, D., Scott, S., & Kinsman, L. (2019). Development of a program theory for clinical pathways in hospitals: Protocol for a realist review. Systematic Reviews, 8(1), 1–7. https://doi.org/10.1186/s13643-019-1046-0
Maadi, H., Soheilifar, M. H., Choi, W., Moshtaghian, A., & Wang, Z. (2021). Trastuzumab mechanism of action; 20 years of research to unravel a dilemma. Cancers, 13(14), 1–17. https://doi.org/10.3390/cancers13143540
Mamo, G., Worku, A., Lemma, S., & Demas, T. (2017). Cost of illness of breast cancer patients on chemotherapy in Addis Ababa Public Hospitals, the case of Tikur Anbessa specialized teaching hospital-Cross-sectional types of study. Health Economics & Outcome Research: Open Access, 03(04). https://doi.org/10.4172/2471-268x.1000142
Ministry of Health Republic of Indonesia. (2014). Peraturan Menteri Kesehatan Nomor 27 Tahun 2014 Tentang Petunjuk Teknis Sistem INA CBGs. http://hukor.kemkes.go.id/hukor/detail/1497/petunjuk-teknis-sistem-indonesian-case-base-groups-ina-cbgs
Ministry of Health Republic Indonesia. (2015). Peraturan Menteri Kesehatan Republik Indonesia No. 85 Tahun 2015 Tentang Pola Tarif Nasional Rumah Sakit. Menteri Kesehatan Republik Indonesia. https://peraturan.bpk.go.id/Details/116591/permenkes-no-85-tahun-2015
Ministry of Health Republic of Indonesia. (2018). Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/Menkes/414/2018 Tentang Pedoman Nasional Pelayanan Kedokteran Tata Laksana Kanker Payudara (HK.01.07/MENKES/414/2018). Health Minister of Republic Indonesia. https://yankes.kemkes.go.id/unduhan/fileunduhan_1610414392_632733.pdf
Ministry of Health Republic Indonesia. (2023). Peraturan Menteri Kesehatan Republik Indonesia No. 3 Tahun 2023 Tentang Standar Tarif Pelayanan Kesehatan Dalam Penyelenggaraan Program Jaminan Kesehatan. Health Minister of Republic Indonesia. https://farmalkes.kemkes.go.id/unduh/permenkes-3-2023-standar-tarif-pelayanan-kesehatan-dalam-penyelenggaraan-program-jaminan-kesehatan/
Ministry of Health Republic of Indonesia: Research and Health Development Agency. (2018). Hasil utama RISKESDAS 2018. Health Minister of Republic Indonesia. https://kesmas.kemkes.go.id/konten/105/0/020417-hasil-riskesdas-2018
Mariotto, A. B., Enewold, L., Zhao, J., Zeruto, C. A., & Robin Yabroff, K. (2020). Medical care costs associated with cancer survivorship in the United States. Cancer Epidemiology Biomarkers and Prevention, 29(7), 1304–1312. https://doi.org/10.1158/1055-9965.EPI-19-1534
NCCN. (2020). Breast cancer – Invasive stage I-III. NCCN Guidelines for Patients. https://www2.tri-kobe.org/nccn/guideline/breast/english/breast.pdf
Patty, Y. F. P. P., Nita, Y., & Libriansyah. (2022). Cost of illness analysis of diabetes mellitus with complications in one hospital in Surabaya. Pharmacy Education, 22(2), 254–258. https://doi.org/10.46542/pe.2022.222.254258
Pisu, M., Henrikson, N. B., Banegas, M. P., & Yabroff, K. R. (2018). Costs of cancer along the care continuum: What we can expect based on recent literature. Cancer, 124(21), 4181–4191. https://doi.org/10.1002/cncr.31643
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. https://doi.org/10.3322/caac.21660
World Health Organisation. (2023). Breast cancer (Issue July). https://www.who.int/news-room/fact-sheets/detail/breast-cancer
Xu, D., Chen, X., Li, X., Mao, Z., Tang, W., Zhang, W., Ding, L., & Tang, J. (2019). Addition of capecitabine in breast cancer first-line chemotherapy improves survival of breast cancer patients. Journal of Cancer, 10(2), 418–429. https://doi.org/10.7150/jca.29739
Yabroff, K. R., Mariotto, A., Tangka, F., Zhao, J., Islami, F., Sung, H., Sherman, R. L., Henley, S. J., Jemal, A., & Ward, E. M. (2021). Annual Report to the Nation on the Status of Cancer, Part 2: Patient Economic Burden Associated With Cancer Care. JNCI: Journal of the National Cancer Institute, 113(12), 1670–1682. https://doi.org/10.1093/jnci/djab192
