Study On Diagnosis And Treatment Status And Economic Burden Of Lung Cancer And Precancerous Lesions In Anhui Province

Objectives Through the classification of lung cancer disease stages and pathological stages,we understand the current situation of lung cancer and precancerous lesion patients in Anhui Province and the economic burden of the disease,and analyze the utilization of health services in the treatment process and the patients’ costs and reimbursement,and propose measures to reasonably reduce or control the economic burden of lung cancer patients,so as to raise people’s awareness of lung cancer disease prevention and treatment,and promote the rational allocation and use of medical and health resources in Anhui Province.Methods The study population was all lung cancer patients or precancerous lesions in inpatient and outpatient clinics in 2 tertiary hospitals in Hefei from September 2021 to October 2022.The clinical stage of the patients and whether they had completed all treatments in the corresponding treatment stage were confirmed according to the case information provided by the hospitals,and the patients were included in the corresponding treatment stage.Case information over-entry and questionnaire follow-up survey were used to collect data:(1)Case information excerpts were made through the hospital information system(HIS)for lung cancer patients and patients with precancerous lesions who met the inclusion criteria,including basic patient information,the source and number of pathological diagnoses,examination methods,main treatment means and other treatment information,as well as direct medical expenses(the part of consultation in our hospital).(2)A structured electronic questionnaire was used to follow up with patients or their family members by telephone to investigate the patient’s direct non-medical costs and indirect costs and other related disease burden,including direct medical costs,direct non-medical costs and indirect costs incurred by the patient for treatment of lung cancer or precancerous lesions..(3)Epi Data3.1 and SPSS23.0software were used for statistical analysis.Descriptive analysis was performed on the sociodemographic data and cost payment of lung cancer patients to obtain the basic information of patients,health service utilization and the current status of economic burden of disease.Regarding the analysis of the effect of different stages and phases on economic burden: the Kruskal-Wallis test was used for univariate analysis for multiple samples,and the Mann Whitney rank sum test was used for two samples.Results(1)A total of 482 lung cancer patients were included in the study for this investigation.Among them,there were 201,136,86,and 59 patients in the initial stage,radiotherapy stage,follow-up/review stage,and recurrence/metastasis/progression stage,respectively;and 86,123,79,99,and 95 patients in the pre-cancerous,stage I,stage II,stage III,and stage IV lung cancer studies,respectively.(2)More than half of lung cancer patients were diagnosed with the disease because of obvious symptoms;The utilization of health services varies by stage/stage;Patients with lung cancer generally had a long interval between the first visit and the last visit.The time difference of the four stages was 157±135 days,325±149 days,855±431 days and 981±549 days,respectively.The time interval of the recurrence/metastasis/progression stage was the longest,while that of the initial stage was the shortest.(3)Hospitalization is the main use of medical services,and the length of hospitalization varies with the disease stage and stage of patients,which directly affects the level of direct medical expenses.(4)Patients’ medical expenses come from a single source,mainly from family income and medical insurance.After statistical analysis,the financial burden of lung cancer patients was significantly associated with the stage of disease and pathological stage(p < 0.05).(5)The total per capita costs of lung cancer patients in the four stages were 63,591 ±43,241,130,705 ± 127,755,92,499 ± 128,908,and 379,412 ± 1,180,333 yuan,respectively.The total per capita costs for the five stages were RMB 35,368±21490,RMB 67,650±47921,RMB 79318±83028,RMB 223,795±926278,and RMB220,689±124,326,respectively.The direct medical expenses and indirect expenses accounted for a larger proportion of the total cost composition;the cost of drugs was relatively high among the direct medical expenses,the expenses on transportation and nutrition were higher among the direct non-medical expenses,and the cost of lost work of family members was significantly higher than the lost work of the patients themselves among the indirect expenses.(6)The average per capita/per capita reimbursement ratio for outpatient care in the four stages is low per capita,and individual outpatient out-of-pocket payment accounts for a larger proportion;the per capita out-of-pocket payment for hospitalization keeps increasing with the growth of the stage,and the out-of-pocket payment burden of patients in each stage is also relatively heavy.Conclusions(1)There are certain defects in the diagnosis and treatment process of lung cancer patients.The way of diagnosis of lung cancer patients is relatively simple,and patients with different stages and pathological stages have different choices of outpatient and hospitalization.(2)The economic burden of lung cancer patients is heavy,direct medical expenses and indirect expenses are the main sources of the economic burden of lung cancer patients,and the main expenses of different disease stages and pathological stages are different.(3)There are differences in the expenditure types of different stages/installments.(4)The economic burden of lung cancer is closely related to the stage and pathological stage of lung cancer.Gender,age,treatment methods and so on lead to the difference in the economic burden of disease.The out-of-pocket expenses of lung cancer patients are still high and the reimbursement rate of outpatient service is low.