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Multicenter Study
. 2017 Apr 28;36(1):41.
doi: 10.1186/s40880-017-0209-4.

Expenditure and financial burden for the diagnosis and treatment of colorectal cancer in China: a hospital-based, multicenter, cross-sectional survey

Hui-Yao Huang  1 , Ju-Fang Shi  2 , Lan-Wei Guo  1   3 , Ya-Na Bai  4 , Xian-Zhen Liao  5 , Guo-Xiang Liu  6 , A-Yan Mao  7 , Jian-Song Ren  1 , Xiao-Jie Sun  8 , Xin-Yu Zhu  1   4 , Le Wang  1 , Bing-Bing Song  9 , Ling-Bin Du  10 , Lin Zhu  11 , Ji-Yong Gong  12 , Qi Zhou  13 , Yu-Qin Liu  14 , Rong Cao  15 , Ling Mai  16 , Li Lan  17 , Xiao-Hua Sun  18 , Ying Ren  19 , Jin-Yi Zhou  20 , Yuan-Zheng Wang  21 , Xiao Qi  22 , Pei-An Lou  23 , Dian Shi  1   4 , Ni Li  1 , Kai Zhang  1 , Jie He  1 , Min Dai  24
Affiliations
Multicenter Study

Expenditure and financial burden for the diagnosis and treatment of colorectal cancer in China: a hospital-based, multicenter, cross-sectional survey

Hui-Yao Huang et al. Chin J Cancer. .

Abstract

Background: The increasing prevalence of colorectal cancer (CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.

Methods: We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan (CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup (hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure.

Results: A total of 2356 patients with a mean age of 57.4 years were included, 57.1% of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY. The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage I, II, III, and IV disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3% of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups (P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more, whereas those with a lower household income and those who underwent surgery spent less (all P < 0.05).

Conclusions: For patients in China, direct expenditure for the diagnosis and treatment of CRC seemed catastrophic, and non-medical expenditure was non-ignorable. The financial burden varied among subgroups, especially among patients with different clinical stages of disease, which suggests that, in China, CRC screening might be cost-effective.

Keywords: China; Colorectal neoplasms; Direct expenditure; Financial burden.

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Figures

Fig. 1
Fig. 1
Medical and non-medical expenditures for diagnosis and treatment of patients with stage I–IV colorectal cancer. CNY Chinese Yuan, CI confidence interval. Of the 2356 patients included, 24 have no information of clinical stage
Fig. 2
Fig. 2
Proportional breakdown of non-medical expenditures for diagnosis and treatment of colorectal cancer
See this image and copyright information in PMC

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