Measuring the national tariff and patient economic burden of chemotherapy treatment for lymphoma cancer
DOI:
https://doi.org/10.46542/pe.2024.243.381387Keywords:
Cancer, Cost of illness, Economic burden, Insurance claim review, Lymphoma, National tariffAbstract
Background: Chemotherapy is the most current alternative treatment that requires many resources and long-term arrangements. All stages of lymphoma cancer use this therapeutic modality. The costs become a financial burden for patients, families, service providers, and the government.
Objective: This study aims to estimate the economic burden and measure the adequacy of national tariffs for lymphoma cancer patients’ chemotherapy.
Method: This research is a cost analysis study examining retrospective data. The analysis uses a prevalence approach and bottom-up processes. The secondary data comprises treatment and claim costs borne by lymphoma cancer patients undergoing chemotherapy at a teaching hospital in Indonesia from May 2020 to May 2021. Quantitative analysis was used to calculate the cost of illness.
Results: The data shows that the economic burden of 55 lymphoma cancer patients receiving chemotherapy was USD 38,958.70 per year. Lymphoma patients paid USD 708.34 or about one-six GDP for each chemotherapy visit. The margin between the value of insurance claims and medical costs is from USD 8.41 to 110.51.
Conclusion: The economic burden for lymphoma chemotherapy is unreasonable, but the revenue from the national tariffs is minimal. Hence, the government should promote prevention programmes more than curative ones to minimise lymphoma cancer.
References
Adida, E., Mamani, H., & Nassiri, S. (2016). Bundled Payment vs. Fee-for-Service: Impact of Payment Scheme on Performance. Management Science, 63(5), 1606–1624. https://doi.org/10.1287/mnsc.2016.2445
Crawford S. (2013). Is it time for a new paradigm for systemic cancer treatment? Lessons from a century of cancer chemotherapy. Frontiers in pharmacology, 4, 68. https://doi.org/10.3389/fphar.2013.00068
Foroughi, Z., Ebrahimi, P., Aryankhesal, A., Maleki, M., & Yazdani, S. (2022). Hospitals during economic crisis: A systematic review based on resilience system capacities framework. BMC Health Services Research, 22(1), 1–14. https://doi.org/10.1186/s12913-022-08316-4
Hoppe, R. T., Advani, R. H., Ai, W. Z., Ambinder, R. F., Armand, P., Bello, C. M., Benitez, C. M., Bierman, P. J., Boughan, K. M., Dabaja, B., Gordon, L. I., Hernandez-Ilizaliturri, F. J., Herrera, A. F., Hochberg, E. P., Huang, J., Johnston, P. B., Kaminski, M. S., Kenkre, V. P., Khan, N., Ogba, N. (2020). NCCN guidelines: Hodgkin lymphoma, Version 2.2020. Journal of the National Comprehensive Cancer Network, 18(6), 755–781. https://doi.org/10.6004/jnccn.2020.0026
Horwitz, S. M., Zelenetz, A. D., Gordon, L. I., Wierda, W. G., Abramson, J. S., Advani, R. H., Andreadis, C. B., Bartlett, N., Byrd, J. C., Fayad, L. E., Fisher, R. I., Glenn, M. J., Habermann, T. M., Lee Harris, N., Hernandez-Ilizaliturri, F., Hoppe, R. T., Kaminski, M. S., Kelsey, C. R., Kim, Y. H., Porcu, P. (2016). NCCN guidelines insights: Non-Hodgkin’s lymphomas, version 3.2016. Journal of the National Comprehensive Cancer Network, 14(9), 1067–1079. https://doi.org/10.6004/jnccn.2016.0117
Jo, C. (2014). Cost-of-illness studies: Concepts, scopes, and methods. Clinical and Molecular Hepatology, 20(4), 327–337. https://doi.org/10.3350/cmh.2014.20.4.327
Kementrian Kesehatan Republik Indonesia. (2012). Pedoman penerapan kajian farmakoekonomi (P. Sarnianto, F. Zorni, & E. Gusnellyanti (eds.)). Kementrian Kesehatan Republik Indonesia. https://farmalkes.kemkes.go.id/unduh/pedoman-penerapan-kajian-farmakoekonomi/
Kementrian Kesehatan Republik Indonesia. (2023a). Nilai klaim harga obat program rujuk balik, obat penyakit kronis di fasilitas kesehatan rujukan tingkat lanjutan, obat kemoterapi, dan obat alteplase. https://farmalkes.kemkes.go.id/unduh/kmk-no-hk-01-07-menkes-1276-2023-ttg-nilai-klaim-harga-obat-program-rujuk-balik-obat-penyakit-kronis-obat-kemoterapi-dan-obat-alteplase/
Kementrian Kesehatan Republik Indonesia. (2023b). Peraturan Menteri Kesehatan Republik Indonesia No. 3 Tahun 2023 Tentang Standar Tarif Pelayanan Kesehatan Dalam Penyelenggaraan Program Jaminan Kesehatan. Menteri Kesehatan Republik Indonesia. https://farmalkes.kemkes.go.id/unduh/permenkes-3-2023-standar-tarif-pelayanan-kesehatan-dalam-penyelenggaraan-program-jaminan-kesehatan/
Ly, D. P., & Cutler, D. M. (2018). Factors of U.S. Hospitals Associated with improved profit margins: An observational study. Journal of General Internal Medicine, 33(7), 1020–1027. https://doi.org/10.1007/s11606-018-4347-4
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
Muneishi, M., Nakamura, A., Tachibana, K., Suemitsu, J., Hasebe, S., Takeuchi, K., & Yakushijin, Y. (2018). Retrospective analysis of first-line treatment for follicular lymphoma based on outcomes and medical economics. International journal of clinical oncology, 23(2), 375–381. https://doi.org/10.1007/s10147-017-1202-2
Mounié, M., Costa, N., Conte, C., Petiot, D., Fabre, D., Despas, F., Lapeyre-Mestre, M., Laurent, G., Savy, N., & Molinier, L. (2020). Real-world costs of illness of Hodgkin and the main B-Cell Non-Hodgkin lymphomas in France. Journal of Medical Economics, 23(3), 235–242. https://doi.org/10.1080/13696998.2019.1702990
National Cancer Institute. (2023). Financial Burden of Cancer Care. The United States of America: National Cancer Institute. https://progressreport.cancer.gov/after/economic_burden#field_most_recent_estimates
National Health Commission of the PRC. (2022). National guidelines for diagnosis and treatment of malignant lymphoma 2022 in China (English version). Chinese Journal of Cancer Research, 34(5), 425–446. https://doi.org/10.21147/j.issn.1000-9604.2022.05.01
Negara, S. B. S. M. K., Octavia, D. R., & Utami, P. R. (2021). The comparison of the actual cost to case-mix of type 2 diabetes mellitus inpatient in Pandan Arang Boyolali hospital. Pharmacy Education, 21(2), 269–274. https://doi.org/10.46542/pe.2021.212.269274
Painschab, M. S., Kohler, R., Kimani, S., Mhango, W., Kaimila, B., Zuze, T., Mithi, V., Kasonkanji, E., Mumba, N., Nyasosela, R., Wheeler, S., & Gopal, S. (2021). Comparison of best supportive care, CHOP, or R-CHOP for treatment of diffuse large B-cell lymphoma in Malawi: A cost-effectiveness analysis. The Lancet Global Health, 9(9), e1305–e1313. https://doi.org/10.1016/S2214-109X(21)00261-8
Paul III, D. P., Brunoni, J., Dolinger, T., Walker, I., & Wood, D. (2014). How effective is capitation at reducing health care costs. Paper presented at the 41st Annual Meeting of the Northeast Business & Economics Association, West Long Branch, New Jersey. Marshal Digital Scholar. https://mds.marshall.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1123&context=mgmt_faculty
Pavlasova, G., & Mraz, M. (2020). The regulation and function of CD20: An “enigma” of B-cell biology and targeted therapy. Haematologica, 105(6), 1494–1506. https://doi.org/10.3324/haematol.2019.243543
Puspandari, D. A., Mukti, A. G., & Kusnanto, H., Kebijakan, P., & Asuransi, M. (2015). Determinant factors of drug cost for breast cancer patient in Indonesia. Jurnal Kebijakan Kesehatan Indonesia, 04(03), 104–108.
Reis, A., Ihle, P., Paulus, U., Ferber, L. V, Diehl, V., & Walshe, R. (2006). Cost of illness of malignant lymphoma in Germany. European Journal of Cancer Care, 15(4), 379–385. https://doi.org/https://doi.org/10.1111/j.1365-2354.2006.00676.x
Stricker, T. P., & Kumar, V. (2021). Neoplasia. In V. Kumar, A. K. Abbas, & J. C. Aster (Eds.), Robbins & Cotran pathologic basis of disease (10th ed., pp. 259–331). Sauders Elsevier.
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
The Global Cancer Observatory. (2020). Cancer incident in Indonesia. International Agency for Research on Cancer. World Health Organization. https://gco.iarc.fr/today/data/factsheets/populations/360-indonesia-fact-sheets.pdf
