Medical expenditure for esophageal cancer in China: a 10-year multicenter retrospective survey (2002-2011)

Abstract

Background: Esophageal cancer is associated with substantial disease burden in China, and data on the economic burden are fundamental for setting priorities in cancer interventions. The medical expenditure for the diagnosis and treatment of esophageal cancer in China has not been fully quantified. This study aimed to examine the medical expenditure of Chinese patients with esophageal cancer and the associated trends.

Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 37 hospitals in 13 provinces/municipalities across China as a part of the Cancer Screening Program of Urban China. For each esophageal cancer patient diagnosed between 2002 and 2011, clinical information and expense data were extracted by using structured questionnaires. All expense data were reported in Chinese Yuan (CNY; 1 CNY = 0.155 USD) based on the 2011 value and inflated using the year-specific health care consumer price index for China.

Results: A total of 14,967 esophageal cancer patients were included in the analysis. It was estimated that the overall average expenditure per patient was 38,666 CNY, and an average annual increase of 6.27% was observed from 2002 (25,111 CNY) to 2011 (46,124 CNY). The average expenditures were 34,460 CNY for stage I, 39,302 CNY for stage II, 40,353 CNY for stage III, and 37,432 CNY for stage IV diseases (P < 0.01). The expenditure also differed by the therapy type, which was 38,492 CNY for surgery, 27,933 CNY for radiotherapy, and 27,805 CNY for chemotherapy (P < 0.05). Drugs contributed to 45.02% of the overall expenditure.

Conclusions: These conservative estimates suggested that medical expenditures for esophageal cancer in China substantially increased in the last 10 years, treatment for early-stage esophageal cancer costs less than that for advanced cases, and spending on drugs continued to account for a considerable proportion of the overall expenditure.

Keywords: China; Diagnosis and treatment; Esophageal neoplasms; Medical expenditure.

Fig. 1

Medical expenditure for esophageal cancer diagnosis and treatment per patient in China, by province/municipality. China is divided into the eastern, central, and western regions. Guangdong, Beijing, Shandong, Zhejiang, Liaoning, Jiangsu, and Hebei belong to the eastern region of China; Hunan, Heilongjiang, and Henan belong to the central region of China; and Xinjiang, Chongqing, and Gansu belong to the western region of China. Each bar indicates the average expenditure with 95% confidence interval in parentheses

Fig. 2

Time trend of medical expenditures and related factors for esophageal cancer diagnosis and treatment in China, 2002–2011. a Time trend of overall average medical expenditures per patient; b time trend of medical expenditures per clinical visit; c: time trend of daily average medical expenditure; d time trend of number of clinical visits per patient; e time trend of the length of hospitalization stay per patient

Fig. 3

Subgroup analysis on time trend of medical expenditures for esophageal cancer diagnosis and treatment per patient in China, 2002–2011. a Time trend of medical expenditures stratified by region in China; b time trend of medical expenditures stratified by hospital type; c time trend of medical expenditures stratified by hospital level; d time trend of medical expenditures stratified by number of clinical visits per patient; e time trend of medical expenditures stratified by age group; f time trend of medical expenditures stratified by pathologic type; g time trend of medical expenditures stratified by clinical stage; h time trend of medical expenditures stratified by therapy type

Fig. 4

The proportional breakdown of medical expenditures for esophageal cancer diagnosis and treatment per patient. Others include the expenditures for oxygen, blood infusion, heating, and so on