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      Medical expenditure for lung cancer in China: a multicenter, hospital-based retrospective survey

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          Abstract

          Background

          Lung cancer is the most prevalent cancer, and the leading cause of cancer-related deaths in China. The aim of this study was to estimate the direct medical expenditure incurred for lung cancer care and analyze the trend therein for the period 2002–2011 using nationally representative data in China

          Methods

          This study was based on 10-year, multicenter retrospective expenditure data collected from hospital records, covering 15,437 lung cancer patients from 13 provinces diagnosed during the period 2002–2011. All expenditure data were adjusted to 2011 to eliminate the effects of inflation using China’s annual consumer price index.

          Results

          The direct medical expenditure for lung cancer care (in 2011) was 39,015 CNY (US$6,041) per case, with an annual growth rate of 7.55% from 2002 to 2011. Drug costs were the highest proportionally in the total medical expenditure (54.27%), followed by treatment expenditure (14.32%) and surgical expenditure (8.10%). Medical expenditures for the disease varied based on region, hospital level, type, and stage.

          Conclusion

          The medical expenditure for lung cancer care is substantial in China. Drug costs and laboratory test are the main factors increasing medical costs.

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          Most cited references24

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          Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

          This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high-quality cancer registry data, the basis for planning and implementing evidence-based cancer control programs, are not available in most low- and middle-income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1-31. © 2018 American Cancer Society.
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            Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010

            Summary Background China has undergone rapid demographic and epidemiological changes in the past few decades, including striking declines in fertility and child mortality and increases in life expectancy at birth. Popular discontent with the health system has led to major reforms. To help inform these reforms, we did a comprehensive assessment of disease burden in China, how it changed between 1990 and 2010, and how China's health burden compares with other nations. Methods We used results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) for 1990 and 2010 for China and 18 other countries in the G20 to assess rates and trends in mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 231 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to China. We assessed relative performance of China against G20 countries (significantly better, worse, or indistinguishable from the G20 mean) with age-standardised rates and 95% uncertainty intervals. Findings The leading causes of death in China in 2010 were stroke (1·7 million deaths, 95% UI 1·5–1·8 million), ischaemic heart disease (948 700 deaths, 774 500–1 024 600), and chronic obstructive pulmonary disease (934 000 deaths, 846 600–1 032 300). Age-standardised YLLs in China were lower in 2010 than all emerging economies in the G20, and only slightly higher than noted in the USA. China had the lowest age-standardised YLD rate in the G20 in 2010. China also ranked tenth (95% UI eighth to tenth) for HALE and 12th (11th to 13th) for life expectancy. YLLs from neonatal causes, infectious diseases, and injuries in children declined substantially between 1990 and 2010. Mental and behavioural disorders, substance use disorders, and musculoskeletal disorders were responsible for almost half of all YLDs. The fraction of DALYs from YLDs rose from 28·1% (95% UI 24·2–32·5) in 1990 to 39·4% (34·9–43·8) in 2010. Leading causes of DALYs in 2010 were cardiovascular diseases (stroke and ischaemic heart disease), cancers (lung and liver cancer), low back pain, and depression. Dietary risk factors, high blood pressure, and tobacco exposure are the risk factors that constituted the largest number of attributable DALYs in China. Ambient air pollution ranked fourth (third to fifth; the second highest in the G20) and household air pollution ranked fifth (fourth to sixth; the third highest in the G20) in terms of the age-standardised DALY rate in 2010. Interpretation The rapid rise of non-communicable diseases driven by urbanisation, rising incomes, and ageing poses major challenges for China's health system, as does a shift to chronic disability. Reduction of population exposures from poor diet, high blood pressure, tobacco use, cholesterol, and fasting blood glucose are public policy priorities for China, as are the control of ambient and household air pollution. These changes will require an integrated government response to improve primary care and undertake required multisectoral action to tackle key risks. Analyses of disease burden provide a useful framework to guide policy responses to the changing disease spectrum in China. Funding Bill & Melinda Gates Foundation.
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              Early appraisal of China's huge and complex health-care reforms.

              China's 3 year, CN¥850 billion (US$125 billion) reform plan, launched in 2009, marked the first phase towards achieving comprehensive universal health coverage by 2020. The government's undertaking of systemic reform and its affirmation of its role in financing health care together with priorities for prevention, primary care, and redistribution of finance and human resources to poor regions are positive developments. Accomplishing nearly universal insurance coverage in such a short time is commendable. However, transformation of money and insurance coverage into cost-effective services is difficult when delivery of health care is hindered by waste, inefficiencies, poor quality of services, and scarcity and maldistribution of the qualified workforce. China must reform its incentive structures for providers, improve governance of public hospitals, and institute a stronger regulatory system, but these changes have been slowed by opposition from stakeholders and lack of implementation capacity. The pace of reform should be moderated to allow service providers to develop absorptive capacity. Independent, outcome-based monitoring and evaluation by a third-party are essential for mid-course correction of the plans and to make officials and providers accountable. Copyright © 2012 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                lgx6301@163.com
                renjiansong@sina.com
                Journal
                Cost Eff Resour Alloc
                Cost Eff Resour Alloc
                Cost Effectiveness and Resource Allocation : C/E
                BioMed Central (London )
                1478-7547
                17 August 2021
                17 August 2021
                2021
                : 19
                : 53
                Affiliations
                [1 ]GRID grid.410736.7, ISNI 0000 0001 2204 9268, School of Health Management, , Harbin Medical University, ; 194 Xuefu Road, Nangang District, Harbin, 150081 China
                [2 ]GRID grid.506261.6, ISNI 0000 0001 0706 7839, Office of Cancer Screening, , National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ; 17 Panjiayuan South Lane, Chaoyang District, Beijing, 100021 China
                [3 ]GRID grid.414008.9, ISNI 0000 0004 1799 4638, Department of Cancer Epidemiology, , The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, ; Zhengzhou, 450008 China
                [4 ]GRID grid.32566.34, ISNI 0000 0000 8571 0482, Institute of Epidemiology and Health Statistics, , Lanzhou University, ; Lanzhou, 730000 China
                [5 ]Hunan Office for Cancer Control and Research, Hunan Provincial Cancer Hospital, Changsha, 410006 China
                [6 ]GRID grid.506261.6, ISNI 0000 0001 0706 7839, Public Health Information Research Office, Institute of Medical Information, , Chinese Academy of Medical Sciences, ; Beijing, 100020 China
                [7 ]GRID grid.27255.37, ISNI 0000 0004 1761 1174, Center for Health Management and Policy, Key Lab of Health Economics and Policy, , Shandong University, ; Jinan, 250012 China
                [8 ]GRID grid.452285.c, Chongqing Office for Cancer Control and Research, Chongqing Cancer Hospital, ; Chongqing, 400030 China
                [9 ]GRID grid.440144.1, ISNI 0000 0004 1803 8437, Science and Education Department of Public Health Division, , Shandong Tumor Hospital, ; Jinan, 250117 China
                [10 ]GRID grid.410734.5, Jiangsu Provincial Center for Disease Control and Prevention, , Institute of Chronic Non-Communicable Diseases Prevention and Control, ; Nanjing, 210009 China
                [11 ]GRID grid.461867.a, ISNI 0000 0004 1765 2646, Cancer Epidemiology Research Center, , Gansu Provincial Cancer Hospital, ; Lanzhou, 730050 China
                [12 ]GRID grid.414008.9, ISNI 0000 0004 1799 4638, Department of Institute of Tumor Research, , The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, ; Zhengzhou, 450008 China
                [13 ]GRID grid.410736.7, ISNI 0000 0001 2204 9268, Heilongjiang Office for Cancer Control and Research, , Affiliated Cancer Hospital of Harbin Medical University, ; Harbin, 150081 China
                [14 ]GRID grid.13394.3c, ISNI 0000 0004 1799 3993, Teaching and Research Department, , Affiliated Cancer Hospital of Xinjiang Medical University, ; Urumqi, 830011 China
                [15 ]GRID grid.459742.9, ISNI 0000 0004 1798 5889, Liaoning Office for Cancer Control and Research, , Liaoning Cancer Hospital & Institute, ; Shenyang, 110042 China
                [16 ]GRID grid.417397.f, ISNI 0000 0004 1808 0985, Zhejiang Office for Cancer Control and Research, , Zhejiang Cancer Hospital, ; Hangzhou, 310022 China
                [17 ]GRID grid.459483.7, Department of Occupational Medicine, , Tangshan People’s Hospital, ; Tangshan, 063001 China
                [18 ]GRID grid.459833.0, ISNI 0000 0004 1799 3336, Ningbo Clinical Cancer Prevention Guidance Center, , Ningbo NO.2 Hospital, ; Ningbo, 315010 China
                [19 ]GRID grid.459652.9, ISNI 0000 0004 1757 7033, Health Department of Kailuan Group, , Kailuan General Hospital, ; Tangshan, 063000 China
                [20 ]Urban Office of Cancer Early Detection and Treatment, Tieling Central Hospital, Tieling, 112000 China
                [21 ]Department of Health Policy and Economic Research, Guangdong Provincial Institute of Public Health, Guangzhou, 511430 China
                [22 ]Institute of Chronic Disease Prevention and Control, Harbin Center for Disease Control and Prevention, Harbin, 150056 China
                [23 ]Department of Control and Prevention of Chronic Non-Communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, 221006 China
                Article
                306
                10.1186/s12962-021-00306-3
                8371812
                34404418
                4a1fdd79-834e-4bca-b398-dd72dd3d03f0
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 31 January 2021
                : 9 August 2021
                Funding
                Funded by: National Key research and development plan of China
                Award ID: 2017YFC1308700
                Award ID: 2017YFC1308705
                Award Recipient :
                Funded by: Cancer Screening Program in Urban China(CanSPUC))
                Funded by: National Nature Science Foundation of China
                Award ID: 71673071
                Award ID: 71503063
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2021

                Public health
                lung cancer,medical expenditure,cost,china
                Public health
                lung cancer, medical expenditure, cost, china

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