Medicinski troškovi palijativne nege bolesnika sa karcinomom
Sažetak
Uvod/Cilj. Maligna oboljenja jedan su od vodećih uzroka smrtnosti u svetu, čije lečenje ima veliki finansijski uticaj na budžete zdravstvenih sistema svakog društva, uključujući Srbiju. Cilj ovog rada bio je da se odredi strukutura najvećih troškova tokom lečenja obolelih od karcinoma u Srbiji. Metode. Retrospektivna analiza baze podataka tipa “odozdo-nagore” sprovedena je da bi se kvantifikovali relevantni troškovi. Analizirani su podaci bolesnika koji su preminuli tokom prve godine nakon postavljanja dijagnoze: demografski podaci, dijagnoza, histologija tumora, troškovi upotrebe svih medicinskih usluga, vreme i uzrok smrti. Svi troškovi su pridodati jednoj od tri kategorije lečenja: primarna, vanbolnička i bolnička nega. Rezultati. Analizirana su 114 bolesnika, pri čemu su najveći deo činili bolesnici sa prisutnim udaljenim metastazama u trenutku postavljanja dijagnoze (48,25%). Vodeći uzrok smrtnosti bili su maligniteti respiratornih organa. Prosečni troškovi po bolesniku bili su značajno različiti u odnosu na vrstu karcinoma, pri čemu su najveći troškovi zabeleženi kod bolesnica sa tumorom dojke (13 114,10 EUR), a najniži kod bolesnika sa melanomom (4,00 EUR). Najveći finansijski uticaj na ukupne troškove odnosio se na lekove, 42% (među njima, troškovi za monoklonska antitela iznosili su 34% sredstava, ili 14% u odnosu na ukupne troškove), zatim troškovi za medicinsku negu u onkologiji (21%), terapiju zračenjem i intervencijsku radiologiju (11%), hirurgiju (9%), dijagnostiku snimanjem (9%) i laboratorijske troškove (8%).
Zaključak. Lečenje obolelih od karcinoma uključuje velike troškove, posebno za lekove za bolesnike u terminalnom stadijumu bolesti, uz nepredvidiv ishod lečenja. Unapređivanjem i finansiranjem programa za ranu detekciju bolesti i odgovarajućom politikom refundiranja na nacionalnom nivou (npr. troškova lečenja monoklonskim antitelima) moglo bi se očekivati više koristi i manje ekonomskog opterećenja društva troškovima za lečenje malignih oboljenja.Reference
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global Cancer statistics. CA Cancer J Clin 2011; 61(2): 69−90.
World Health Organization. Global Burden of the disease 2004 update. Geneva: World Health Organization; 2008.
World Health Organization. World health statistics 2013. Geneva: World Health Organization; 2013.
Uyl-de Groot C. Economic evaluation of cancer therapies: More and better studies will lead to better choices in cancer care. Eur J Cancer 2006; 42(17): 2862−6.
Murthy RS, Lakshminarayana R. Mental health consequences of war: a brief review of research findings. World Psychiatry 2006; 5(1): 25−30.
Papathanasiou K, Gianoulis C, Tolikas A, Dovas D, Koutsos J, Frag-kedakis N, et al. Effect of depleted uranium weapons used in the Balkan war on the incidence of cervical intraepithelial neoplasia (CIN) and invasive cancer of the cervix in Greece. Clin Exp Obstet Gynecol 2005; 32(1): 58−60.
Mihajlović J, Pechlivanoglou P, Miladinov-Mikov M, Zivković S, Postma MJ. Cancer incidence and mortality in Serbia 1999-2009. BMC Cancer 2013; 13: 18.
Institute of Public Health of Serbia. Health Statistical Yearbook of Republic of Serbia 2012. Belgrade: Institute of Public Health of Serbia; 2013.
American Cancer Society. Cancer Facts and Figures 2008. Atlanta, Georgia: American Cancer Society; 2013.
Jason H. Experts debate if the cost of end-of-life cancer care is too high. HemOnc Today [cited 2009 September 10]. Availa-ble from: www.healio.com ›
Luengo-Fernandez R, Leal J, Gray A, Sullivan R. Economic bur-den of cancer across the European Union: a population-based cost analysis. Lancet Oncol 2013; 14(12): 1165−74.
Jakovljevic MB. Resource allocation strategies in Southeastern European health policy. Eur J Health Econ 2013;14(2): 153−9.
Arnold RG, Kotsanos JG. Panel 3: methodological issues in con-ducting pharmacoeconomic evaluations - retrospective and claims database studies. Value Health 1999; 2(2): 82−7.
Jakovljevic M, Rankovic A, Rancic N, Jovanovic M, Ivanovic M, Gajovic O, et al. Radiology Services Costs and Utilization Patterns estimates in Southeastern Europe - A Retrospective Analysis from Serbia. Value Health Reg 2013; 2(2): 218−25.
Milijus D, Zivkovic S, Bozic Z. Cancer incidence and mortality in central Serbia. Belgrade: Institute of Public Health of Serbia “Dr Milan Jovanovic Batut”; 2012.
Leblanc TW, Abernethy AP. Defining quality, disseminating evi-dence, and enforcing guidelines for cancer treatment. Virtual Mentor 2013; 15(8): 713−7.
Institute of Public Health of Serbia. Cancer incidence and mortality in Serbia 2010. Belgrade: Institute of Public Health of Serbia; 2012.
Šipetić T. Marketing and consumption of medicinal products for human use in 2010. Belgrade: Agencija za lekove i medi-cinska sredstva Srbije; 2011. (Serbian)
Šipetić T. Marketing and consumption of medicinal products for human use in 2011. Belgrade: Agencija za lekove i medi-cinska sredstva Srbije; 2012. (Serbian)
Institute of Public Health of Serbia. Health Statistical Yearbook of Republic of Serbia 2011. Belgrade: Institute of Public Health of Serbia; 2012.
Institute of Public Health of Serbia. Health Statistical Yearbook of Republic of Serbia 2010. Belgrade: Institute of Public Health of Serbia; 2011.
Earle C, Neville B, Landrum MB, Ayanian J, Block S, Weeks J. Trends in the Aggressiveness of Cancer Care Near the End of Life. J Clin Oncol 2004; 22(2): 315−21.
Rankovic A, Rancic N, Jovanovic M, Ivanovic M, Gajovic O, Lazic Z, et al. Impact of imaging diagnostics on the budget – Are we spending too much? Vojnosanit Pregl 2013; 70(7): 709−11.
Zweifel P. The Grossman model after 40 years. Eur J Health Econ 2012; 13(6): 677−82.
Radovanovic A, Dagovic A, Jakovljevic M. Economics of cancer re-lated medical care: estimates worldwide and available domestic evidence. Arch Oncol 2011; 19(3−4): 59−63.
Autier P, Ouakrim A, Malvezzi M, Bleiberg H, Jenkins M, Boniol M, et al. Trends in colorectal cancer mortality and screening activities in European countries. Eur J Cancer 2013; 49(2 Suppl): S299.
Marsland T, Robbins G, Marks A, Cassell R, Philips Green D, King K. Reducing Cancer Costs and Improving Collaboration With Payers: A Proposal From the Florida Society of Clinical On-cology. J Oncol Pract 2010; 6(5): 265−9.
Huskamp HA, Keating NL, Malin JL, Zaslavsky AM, Weeks JC, Earle CC, et al. Discussions with physicians about hospice among patients with metastatic lung cancer. Arch Intern Med 2009; 169(10): 954−62.
Kaló Z, Landa K, Doležal T, Vokó Z. Transferability of National Institute for Health and Clinical Excellence recommendations for pharmaceutical therapies in oncology to Central-Eastern European countries. Eur J Cancer Care (Engl) 2012; 21(4): 442−9.