Annual cost of illness of stomach and esophageal cancer patientsin urban and rural areas in China： A multi-center study

Objective： Stomach and esophageal cancer are imposing huge threats to the health of Chinese people whereasthere were few studies on the financial burden of the two cancers.Methods： Costs per hospitalization of all patients with stomach or esophageal cancer discharged betweenSeptember 2015 and August 2016 in seven cities/counties in China were collected, together with their demographicinformation and clinical details. Former patients in the same hospitals were sampled to collect information onannual direct non-medical cost, indirect costs and annual number of hospitalization. Annual direct medical cost wasobtained by multiplying cost per hospitalization by annual number of hospitalization. Annual cost of illness （ACI）was obtained by adding the average value of annual direct medical cost, direct non-medical cost and indirect cost,stratified by sex, age, clinical stage, therapy and pathologic type in urban and rural areas. Costs per hospitalizationwere itemized into eight parts to calculate the proportion of each part. All costs were converted to 2016 US dollars（1 USD：6.6423 RMB）.Results： Totally 19,986 cases were included, predominately male. Mean ages of stomach cancer and urbanpatients were lower than that of esophageal cancer and rural patients. ACI of stomach and esophageal cancerpatients were $10,449 and $13,029 in urban areas, and $2,927 and $3,504 in rural areas, respectively. Greater ACIwas associated with male, non-elderly patients as well as those who were in stage I and underwent surgeries.Western medicine fee took the largest proportion of cost per hospitalization.Conclusions： The ACI of stomach and esophageal cancer was tremendous and varied substantially among thepopulation in China. Preferential policies of medical insurance should be designed to tackle with this burden andfurther reduce the health care inequalities.

Comparison of Top down and Bottom up Cost Approaches in Colon and Rectal Cancer Treatment

Introduction: In recent years, health care expenditures have significantly risen across the world and in Turkey. Because of the limited resources allocated to health, it is very important for countries to conduct studies especially on cost of diseases such as colorectal cancer (CRC) with a high burden of disease and labor loss. The aim of this study was to calculate the cost of treatment for colon and rectal cancers based on two different cost approaches from the perspective of SSI (top-down and bottom-up) and to compare the results obtained. Materials and Methods: Data were obtained from the SSI MEDULA System a total of 62,970 colon and rectal cancer patient for the top-down cost approach. In the bottom-up cost approach, treatment costs were determined based on the expert opinions. Results: The average cost of treatment per patient for colon cancer was determined as 3055.5 TL, for rectal cancer was determined as 4146.2 TL with the top-down cost approach. The average cost of treatment per patient for colon cancer was determined as 14,920.4 TL, for rectal cancer was determined as 17,904.6 TL according to the bottom-up cost approach. Conclusion: Since the bottom-up cost approach provides more detailed information on the cost of illness, and thereby on the use of resources allocated to health, it is thought that the combined use of these two cost approaches completes each other’s weaknesses.

Population-level economic burden of lung cancer in China:Provisional prevalence-based estimations,2017-2030

Objective:Population-level economic burden is essential for prioritizing healthcare resources and healthcare budget making in the future.However,little is known about the economic burden of lung cancer in China.Methods:A prevalence-based approach was adopted to estimate the economic burden of lung cancer,including direct expenditure(medical and non-medical)and indirect cost(disability and premature death).Data on direct expenditure and work-loss days per patient in each year post-diagnosis were obtained from two primary surveys.Other parameters were obtained from literatures and official reports.Projections were conducted based on varying parameters.All expenditure data were reported in United States dollars(USD)using 2017 value(exchange rate:1 USD=6.760 CNY),with the discount rate of 3%.Results:The total economic burden of lung cancer was estimated to be 25,069 million USD in China in 2017(0.121%of gross domestic productivity,GDP).The estimated direct expenditure was 11,098 million USD,up to1.43%of total healthcare expenditure for China,covering 10,303 million USD and 795 million USD for medical and non-medical expenditure,respectively.The estimated indirect cost was 13,971 million,including 1,517 million USD due to disability and 12,454 million USD due to premature death.Under current assumptions,the projected total economic burden would increase to 30.1 billion USD,40.4 billion USD,and 53.4 billion USD in 2020,2025,and 2030,accounting for 0.121%,0.131%,and 0.146%of China's GDP,respectively.However,if China meets the United Nation sustainable development goal of reducing premature death from non-communicable diseases by one-third by 2030,the total economic burden in 2030 would be 31.9 billion USD,0.087%of China's GDP.Conclusions:The economic burden of lung cancer in China in 2017 is substantial and more likely to increase significantly in the future.Policy makers need to take urgent actions in budget making for health systems.The economic burden could be alleviated by reducing the disease burden of lung cancer via effective control and prevention actions.

Caregiver burden:A concept analysis

Objective:Caregiver burden is used frequently within the nursing literature.It has not yet been clearly defined as there are different opinions regarding this concept.The purpose of this paper is to provide clarity surrounding the concept caregiver burden.Methods:An electronic search of MEDLINE,CINAHL,Health Source Nursing/Academic Edition and Academic Search Complete(ASC)of EBSCO,China National Knowledge Infrastructure(CNKI)and Google Scholar were searched with a limit of 10 years and published in the English or Chinese language.The paper adopted the framework by Walker and Avant.The attributes,antecedents,consequences and uses of the concept were identified.Results:At total of 33 articles were included.The three attributes of caregiver burden were identified as self-perception,multifaceted strain,and over time.The antecedents included insufficient financial resources,multiple responsibility conflict,lack of social activities.The consequences of caregiver burden resulted in negative change which included decreased care provision,decrease in quality of life,physical and psychological health deterioration.Conclusion:A definition of caregiver burden was developed.Tools to measure caregiver burden were identified.The findings from this analysis can be used in nursing practice,nursing education,research and administration.