1996-2014年中国恶性肿瘤经济负担的系统评价

Economic burden of cancer in China during 1996-2014： a systematic review

目的了解1996-2014年中国恶性肿瘤经济负担的研究状况。方法采用“癌症”“经济负担”“费用”“成本”等关键词，检索中国知网、万方数据和PubMed文献库1996-2014年发表的文献。从研究对象的信息来源、研究方法和数据结果等方面进行摘录，所有呈现费用数据均以中国医疗保健类居民消费价格指数贴现到2013年。结果最终纳入研究91项，其中55项发表于近5年,涉及肺癌的研究最多（32项）。83项基于个体的研究中,有77项为个体患者病案摘录，数据多为单一直接医疗费用，分析指标以例均和日均费用多见。1996-2014年例均费用趋势结果显示，所有癌种的绝大部分费用在1万元～3万元，其中肺癌和乳腺癌的研究间差异较大（1万元～9万元），食管癌和胃癌的研究间差异略小（1万元～5万元），绝大部分宫颈癌例均费用在2万元内。各癌种日均费用在近20年间总体呈上升趋势（3～7倍）,各研究间离散程度较小。基于人群的研究仅8项，其中全国人群层面恶性肿瘤经济负担跨度为326．3亿元～1007．4亿元。无论是基于个体还是基于人群的研究，对直接非医疗费用、间接费用和无形成本所致经济负担的报道均较少。结论中国恶性肿瘤经济负担评价数据仍有限且结果可比性较差，尤其是在人群层面；例均费用数据可能存在低估。

Objective To explore the current status of research on economic burden of cancer in China from 1996 to 2014. Methods The key words including cancer, economic burden, expenditure, cost were used to retrieve the literatures published in CNKI and Wanfang （the two most commonly used databases for literature in Chinese） and PubMed during 1996-2014. A total of 91 studies were included after several exclusionary procedures. Information on subjects and data source, methodology, main results were structurally abstracted. All the expenditure data were discounted to year of 2013 value using China＇s health care consumer price indices. Results More than half of the included studies were published over the past 5 years, 32 of the studies were about lung cancer. Among the 83 individual-based surveys, 77 were hospital- based and obtained data via individually medical record abstraction, and most of which only considered the direct medical expenditure. Expenditure per cancer patient and expenditure per diem were the most commonly used outcome indicators. Majority of the findings on expenditure per cancer patient ranged from 10 thousands to 30 thousands Chinese Yuan （ CNY）, with larger disparity in lung and breast cancer （ ranged from 10 thousands to 90 thousands CNY）, narrower difference in esophageal and stomach cancer （ranged from 10 thousands to 50 thousands CNY）, and most stable trend in cervical cancer （ almost all the values less than 20 thousands CNY）. Without exception, the expenditures per diem for all the common cancers were increasing over the period from 1996 to 2014 （3-7 fold increase）. Only 8 population-level economic burden studies were included and the reported expenditure of cancer at national level ranged from 32.6 billions to 100.7 billions CNY.Conclusions Evidence on economic burden of cancer in China from 1996 to 2014 are limited and weakly comparable, particularly at a population level, and the reported expenditure per patient may be underestimated.