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Zhang L, Zhuang X, Yang X, Xu F, Wang N, Guo Z, Chen J, Ding D. Analysis of hospitalization expenses and influencing factors for elderly cancer patients in a tertiary hospital in Dalian, China: a five‑year retrospective study. BMC Cancer 2024; 24:864. [PMID: 39026195 PMCID: PMC11264680 DOI: 10.1186/s12885-024-12635-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/12/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Because the proportion of elderly individuals and the incidence of cancer worldwide are continually increasing, medical costs for elderly inpatients with cancer are being significantly increasing, which puts tremendous financial pressure on their families and society. The current study described the actual direct medical costs of elderly inpatients with cancer and analyzed the influencing factors for the costs to provide advice on the prevention and control of the high medical costs of elderly patients with cancer. METHOD A retrospective descriptive analysis was performed on the hospitalization expense data of 11,399 elderly inpatients with cancer at a tier-3 hospital in Dalian between June 2016 and June 2020. The differences between different groups were analyzed using univariate analysis, and the influencing factors of hospitalization expenses were explored by multiple linear regression analysis. RESULTS The hospitalization cost of elderly cancer patients showed a decreasing trend from 2016 to 2020. Specifically, the top 3 hospitalization costs were material costs, drug costs and surgery costs, which accounted for greater than 10% of all cancers according to the classification: colorectal (23.96%), lung (21.74%), breast (12.34%) and stomach cancer (12.07%). Multiple linear regression analysis indicated that cancer type, surgery, year and length of stay (LOS) had a common impact on the four types of hospitalization costs (P < 0.05). CONCLUSION There were significant differences in the four types of hospitalization costs for elderly cancer patients according to the LOS, surgery, year and type of cancer. The study results suggest that the health administration department should enhance the supervision of hospital costs and elderly cancer patient treatment. Measures should be taken by relying on the hospital information system to strengthen the cost management of cancer diseases and departments, optimize the internal management system, shorten elderly cancer patients LOS, and reasonably control the costs of disease diagnosis, treatment and department operation to effectively reduce the economic burden of elderly cancer patients.
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Affiliation(s)
- Lilin Zhang
- Medical Department, Central Hospital of Dalian University of Technology, Dalian, 116033, China
| | - Xijing Zhuang
- Medical Department, Central Hospital of Dalian University of Technology, Dalian, 116033, China
| | - Xiumei Yang
- Group Work Department, Central Hospital of Dalian University of Technology, Dalian, 116033, China
| | - Feng Xu
- Medical Department, Central Hospital of Dalian University of Technology, Dalian, 116033, China
| | - Nan Wang
- Medical Department, Central Hospital of Dalian University of Technology, Dalian, 116033, China
| | - Zhanfang Guo
- Medical Department, Central Hospital of Dalian University of Technology, Dalian, 116033, China
| | - Junfeng Chen
- College of Public Health, Dalian Medical University, Dalian, 116044, China
| | - Ding Ding
- College of Public Health, Dalian Medical University, Dalian, 116044, China.
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Wang Z, Han W, Xue F, Zhao Y, Wu P, Chen Y, Yang C, Gu W, Jiang J. Nationwide gastric cancer prevention in China, 2021-2035: a decision analysis on effect, affordability and cost-effectiveness optimisation. Gut 2022; 71:2391-2400. [PMID: 35902213 DOI: 10.1136/gutjnl-2021-325948] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 07/08/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To project future trajectories of the gastric cancer (GC) burden in China under different scenarios of GC prevention and identify strategies to improve affordability and cost-effectiveness. DESIGN Using a cohort of Chinese men and women born during 1951-1980, we assumed that different prevention strategies were conducted, including eradication of Helicobacter pylori (Hp) and endoscopy screening (one-time, annual, biennial, triennial or stratified according to personal risk). We performed a literature search to identify up-to-date data and populate a Markov model to project the number of new GC cases and deaths during 2021-2035, as well as resource requirements and quality-adjusted life-years (QALYs). We examined the impacts of general (among the whole population) and targeted (high-risk population) prevention. RESULTS During 2021-2035, 10.0 million new GC cases and 5.6 million GC deaths would occur, with 7.6%-35.5% and 6.9%-44.5%, respectively, being avoidable through various prevention strategies. Relative to the status quo, Hp eradication was a cost-saving strategy. General annual screening dominated other screening strategies, but cost more than CNY 70 000 per QALY gained (willingness-to-pay) compared with Hp eradication. Among endoscopy strategies, targeted screening resulted in 44%-49% lower cost per QALY gained over the status quo than general screening. Among high-risk population, tailoring the screening frequency according to personal risk could reduce endoscopy-related resources by 22% compared with biennial screening and by 55% compared with annual screening, CONCLUSION: Our findings provide important input for future decision-making and investment, highlighting the need and feasibility for China to include GC prevention in its national health plans.
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Affiliation(s)
- Zixing Wang
- Department of Epidemiology and Biostatistics, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Basic Medical Sciences, Beijing, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Basic Medical Sciences, Beijing, China
| | - Fang Xue
- Department of Epidemiology and Biostatistics, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Basic Medical Sciences, Beijing, China
| | - Yujie Zhao
- Department of Epidemiology and Biostatistics, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Basic Medical Sciences, Beijing, China
| | - Peng Wu
- Department of Epidemiology and Biostatistics, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Basic Medical Sciences, Beijing, China
| | - Yali Chen
- Department of Epidemiology and Biostatistics, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Basic Medical Sciences, Beijing, China
| | - Cuihong Yang
- Department of Epidemiology and Biostatistics, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Basic Medical Sciences, Beijing, China
| | - Wentao Gu
- Department of Epidemiology and Biostatistics, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Basic Medical Sciences, Beijing, China
| | - Jingmei Jiang
- Department of Epidemiology and Biostatistics, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Basic Medical Sciences, Beijing, China
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Sun D, Zhang M, Wei M, Wang Z, Qiao W, Liu P, Zhong X, Liang Y, Chen Y, Huang Y, Yu W. Ox-LDL-mediated ILF3 overexpression in gastric cancer progression by activating the PI3K/AKT/mTOR signaling pathway. Aging (Albany NY) 2022; 14:3887-3909. [PMID: 35507914 PMCID: PMC9134943 DOI: 10.18632/aging.204051] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
Abstract
Background: This study aimed to investigate the relationship of dyslipidemia and interleukin-enhancer binding factor 3 (ILF3) in gastric cancer, and provide insights into the potential application of statins as an agent to prevent and treat gastric cancer. Methods: The expression levels of ILF3 in gastric cancer were examined with publicly available datasets such as TCGA, and western blotting and immunohistochemistry were performed to determine the expression of ILF3 in clinical specimens. The effects of ox-LDL on expression of ILF3 were further verified with western blot analyses. RNA sequencing, Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene Ontology (GO), and Gene Set Enrichment Analysis (GSEA) pathway analyses were performed to reveal the potential downstream signaling pathway targets of ILF3. The effects of statins and ILF3 on PI3K/AKT/mTOR signaling pathway, cell proliferation, cell cycle, migration and invasion of gastric cancer cells were investigated with Edu assay, flow cytometry and transwell assay. Results: Immunohistochemistry and western blot demonstrated that the positive expression rates of ILF3 in gastric cancer tissues were higher than adjacent mucosa tissues. The ox-LDL promoted the expression of ILF3 in a time-concentration-dependent manner. ILF3 promoted the proliferation, cell cycle, migration and invasion by activating the PI3K/AKT/mTOR signaling pathway. Statins inhibited the proliferation, cell cycle, migration and invasion of gastric cancer by inhibiting the expression of ILF3. Conclusions: These findings demonstrate that ox-LDL promotes ILF3 overexpression to regulate gastric cancer progression by activating the PI3K/AKT/mTOR signaling pathway. Statins inhibits the expression of ILF3, which might be a new targeted therapy for gastric cancer.
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Affiliation(s)
- Danping Sun
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Mingxiang Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Meng Wei
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Zhaoyang Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Wen Qiao
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Peng Liu
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Xin Zhong
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Yize Liang
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Yuanyuan Chen
- Department of Nursing Department, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Yadi Huang
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Wenbin Yu
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
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Wang H, Hua X, Yao N, Zhang N, Wang J, Anderson R, Sun X. The Urban-Rural Disparities and Associated Factors of Health Care Utilization Among Cancer Patients in China. Front Public Health 2022; 10:842837. [PMID: 35309211 PMCID: PMC8931518 DOI: 10.3389/fpubh.2022.842837] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/10/2022] [Indexed: 12/24/2022] Open
Abstract
Objective This study aimed to examine the urban-rural disparities and associated factors of health care utilization among cancer patients in China. Methods This study used the data collected from a cross-sectional survey conducted in China. A total of 1,570 cancer survivors from three urban districts and five rural counties were selected by using a multistage stratified random sampling method. We measured health care utilization with the way of cancer diagnosis, the number of hospitals visited, and receiving alternative therapies. Chi-square test was used to examine the differences between urban and rural cancer patients. Binary logistic regression analysis was performed to explore the determinants of health care utilization. Results Among 1,570 participants, 84.1% were diagnosed with cancer after developing symptoms, 55.6% had visited two and above hospitals, and 5.7% had received alternative therapies. Compared with urban cancer patients, rural ones were more likely to be diagnosed with cancer after developing symptoms (χ2 = 40.04, p < 0.001), while they were less likely to visit more than one hospital (χ2 = 27.14, p < 0.001). Residence area (urban/rural), health insurance type, household income, age at diagnosis, tumor site, stage of tumor, and survival years were significantly associated with health care utilization of cancer patients (p < 0.01). Conclusions Health care utilization was suboptimal among cancers patients in China. Rural cancer patients had less health care utilization including screenings and treatments than urban ones. Policymakers should implement specific strategies to ensure equitable utilization of cancer care. More attention should be paid to the disadvantaged groups and rural cancer patients. Prioritizing health resources allocation is needed to prevent, screen, and treat cancers in rural areas.
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Affiliation(s)
- Haipeng Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine (Key Lab of Health Economics and Policy, National Health Commission), Shandong University, Jinan, China
| | - Xingxing Hua
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Nengliang Yao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine (Key Lab of Health Economics and Policy, National Health Commission), Shandong University, Jinan, China
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
- Center for Cancer Control and Policy Research, School of Public Health, Shandong University, Jinan, China
| | - Nan Zhang
- Center for Cancer Control and Policy Research, School of Public Health, Shandong University, Jinan, China
- Shandong Academy of Medical Sciences, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Jialin Wang
- Center for Cancer Control and Policy Research, School of Public Health, Shandong University, Jinan, China
- Shandong Academy of Medical Sciences, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Roger Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
- University of Virginia Cancer Center, Charlottesville, VA, United States
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine (Key Lab of Health Economics and Policy, National Health Commission), Shandong University, Jinan, China
- Center for Cancer Control and Policy Research, School of Public Health, Shandong University, Jinan, China
- *Correspondence: Xiaojie Sun
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Xu Z, Xue C, Zhao F, Hu C, Wu Y, Zhang L. Hospitalization Costs and Length of Stay in Chinese Naval Hospitals Between 2008 and 2016 Based on Influencing Factors: A Longitudinal Comparison. Mil Med 2021; 185:e282-e289. [PMID: 31287875 DOI: 10.1093/milmed/usz170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/10/2019] [Accepted: 06/14/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION A retrospective review conducted in three hospitals of Guangdong and Hainan, China. To analyze the variation tendency of mean hospitalization costs and length of stay (LOS) in naval hospitals over nine years, paying special attention to the factors affecting hospitalization costs and LOS to provide a reference base for health resource allocation in naval hospitals. MATERIALS AND METHODS A total of 21,375 cases of military patients who were hospitalized and treated in three naval hospitals between January 2008 to December 2016 were extracted from the military health system. There were 16,278 complete and effective cases during those nine years. The situation, trends, and factors influencing hospitalization costs and LOS were analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test, and multiple linear regressions. RESULTS The following factors showed statistically significant differences in hospitalization costs: special care, primary care, year, military rank, critical illness, allergies, and condition (p < 0.0001); and number of hospitalizations, gender, and age (p < 0.01). The following factors showed statistically significant differences in hospital LOS: year, number of hospitalizations, outcomes, military rank, special care, severity of illness, and condition (p < 0.0001); allergy (p < 0.01); and service and gender (p < 0.05). LOS between 2008-2016 showed a decreasing tendency, while hospitalization costs showed an increasing trend. There were 6 factors that affected Abstract (or Structured Summary) both the cost of hospitalization and LOS: special care, year, military rank, condition, allergy, and gender. CONCLUSIONS The results suggest that improving efficiency of military hospital require strengthening hierarchical referrals and controlling hospital LOS. Shortening LOS, optimizing clinical pathways, and reasonably controlling the costs associated with medicines and surgery can help reduce hospitalization costs for military patients. Controlling the growth of hospitalization costs can help avoid the physical and psychological burden of medical over-treatment on patients and may also optimize the allocation of military health resources.
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Affiliation(s)
- Zhenqing Xu
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China.,952nd Hospital of PLA, Glomud, Qinghai, China
| | - Chen Xue
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
| | - Fangjie Zhao
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
| | - Chaoqun Hu
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
| | - Yaomin Wu
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
| | - Lulu Zhang
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
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Zhang T, Chen H, Yin X, He Q, Man J, Yang X, Lu M. Changing trends of disease burden of gastric cancer in China from 1990 to 2019 and its predictions: Findings from Global Burden of Disease Study. Chin J Cancer Res 2021; 33:11-26. [PMID: 33707924 PMCID: PMC7941685 DOI: 10.21147/j.issn.1000-9604.2021.01.02] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective China is one of the countries with the heaviest burden of gastric cancer (GC) in the world. Understanding the epidemiological trends and patterns of GC in China can contribute to formulating effective prevention strategies. Methods The data on incidence, mortality, and disability-adjusted life-years (DALYs) of GC in China from 1990 to 2019 were obtained from the Global Burden of Disease Study (2019). The estimated annual percentage change (EAPC) was calculated to evaluate the temporal trends of disease burden of GC, and the package Nordpred in the R program was used to perform an age-period-cohort analysis to predict the numbers and rates of incidence and mortality in the next 25 years. Results The number of incident cases of GC increased from 317.34 thousand in 1990 to 612.82 thousand in 2019, while the age-standardized incidence rate (ASIR) of GC decreased from 37.56 per 100,000 in 1990 to 30.64 per 100,000 in 2019, with an EAPC of -0.41 [95% confidence interval (95% CI): -0.77, -0.06]. Pronounced temporal trends in mortality and DALYs of GC were observed. In the next 25 years, the numbers of new GC cases and deaths are expected to increase to 738.79 thousand and 454.80 thousand, respectively, while the rates of incidence and deaths should steadily decrease. The deaths and DALYs attributable to smoking were different for males and females. Conclusions In China, despite the fact that the rates of GC have decreased during the past three decades, the numbers of new GC cases and deaths increased, and will continue to increase in the next 25 years. Additional strategies are needed to reduce the burden of GC, such as screening and early detection, novel treatments, and the prevention of risk factors.
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Affiliation(s)
- Tongchao Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Hui Chen
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan 250012, China.,Clinical Research Center of Shandong University, Jinan 250012, China
| | - Xiaolin Yin
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Qiufeng He
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Jinyu Man
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan 250012, China.,Clinical Research Center of Shandong University, Jinan 250012, China
| | - Ming Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China.,Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan 250012, China.,Clinical Research Center of Shandong University, Jinan 250012, China
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Jiang C, Cai S, Duan C, Xu N, Zhou Y, Peng X, Ma X. Analysis of treatment cost for neuroblastoma to the family: a single-center cross-sectional study in China. J Med Econ 2020; 23:961-966. [PMID: 32568600 DOI: 10.1080/13696998.2020.1786392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Neuroblastoma (NB) is notorious in childhood cancer because of its high incidence and poor prognosis. The Children's Oncology Group reported that the 3-year OS in the high-risk (HR) group is 50%, and the HR-NB with bone marrow metastasis in our center is 43.1%. Thousands of families in China suffer from the cost of NB, but the true costs of therapy are unknown; to date, no study has ever performed a detailed therapy costs analysis for NB. The objective of this study was to assess the economic burden of NB treatment in children to the family, to ultimately reduce related expenses for patients and promote the establishment of NB management policy. MATERIALS AND METHODS Data in this cross-sectional study were collected via questionnaires completed by parents at the outpatient clinic and was verified via a computer system. Therapy costs of children with NB of differing risks were analyzed through descriptive statistics (1 CNY ≈ 0.1412 USD). RESULTS Median direct medical costs of low risk (LR), middle risk (MR), and HR NB during treatment were 180.0 (120.0, 300.0), 200.0 (166.0, 300.0), and 650.0 (415.5, 850.0) thousand Chinese yuan (CNY), respectively. Direct non-medical costs including transportation, food, and accommodation were 60.0 (37.0, 100.0), 80.0 (60.0, 120.0), and 100.0 (80.0, 157.5) thousand CNY in the LR, MR, and HR groups, respectively. Additionally, parents accrued work absences to attend treatment, and lost a total of 100.0 (50.0, 150.0) thousand CNY in indirect costs. LIMITATIONS Families whose children had relapsed or died were excluded from this analysis and therefore limited the conclusions drawn. Parents were asked to recall costs since initial diagnosis (1-6 years in the past), but this extended time period may have introduced recall bias. CONCLUSIONS Direct non-medical and indirect costs play an important role in the total treatment costs of NB. Children with NB treated in local hospitals and followed up in hospital specialized in childhood oncology may save many unnecessary expenses. China's healthcare system should establish mechanisms and provide financial support for children with NB.
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Affiliation(s)
- Chiyi Jiang
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Siyu Cai
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chao Duan
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Na Xu
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yuchen Zhou
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoli Ma
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Zhang K, Yin J, Huang H, Wang L, Guo L, Shi J, Dai M. Expenditure and Financial Burden for Stomach Cancer Diagnosis and Treatment in China: A Multicenter Study. Front Public Health 2020; 8:310. [PMID: 32850573 PMCID: PMC7426494 DOI: 10.3389/fpubh.2020.00310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/08/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Stomach cancer is a huge threat to the health of Chinese people. However, few studies have looked into the expenditure and financial burden due to stomach cancer in China. Methods: To estimate the direct (medical and non-medical) and indirect expenditure for diagnosis and treatment for stomach cancer patients in China, a multicenter survey was conducted in 37 tertiary hospitals in 13 provinces across China from 2012 to 2014. Each enrolled patient was interviewed through a structured questionnaire. The medical and non-medical expenditure at different clinical stages, the composition of non-medical expenditure, and the time loss for the cancer patient and their family were assessed. All expenditure data were inflated to the 2014 Chinese Yuan [CNY; 1 CNY = 0.163 USA dollar (USD)]. Results: A total of 2,401 stomach cancer patients with a mean age of 58.1 ± 11.4 years were included, predominately male. The overall average direct expenditure per patient was estimated to be US $9,899 (medical expenditure 91.2%, non-medical expenditure 8.8%), and the expenditures for stage I, II, III, and IV were $8,648, $9,004, $9,810, and $10,816, respectively; expenditure in stage III and IV was significantly higher than that in stages I and II (p < 0.05). One-year out-of-pocket expenditure of a newly diagnosed patient with stomach cancer was $5,368, accounting for 63.8% of their previous-year household income, which led to 79.2% families suffering an unmanageable financial burden. The average loss of time for patients and caregivers was $996. Conclusions: This study indicated that the economic burden of stomach cancer in urban China was onerous. Effective intervention is necessary to reduce the financial burden by reducing the personal payment ratio and increasing the reimbursement ratio.
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Affiliation(s)
- Kai Zhang
- Department of Cancer Prevention, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Yin
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huiyao Huang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Le Wang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lanwei Guo
- Department of Cancer Epidemiology, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Jufang Shi
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Dai
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Hu J, Wang X, Chua EG, He Y, Shu Q, Zeng L, Luo S, Marshall BJ, Liu A, Tay CY. Prevalence and risk factors of Helicobacter pylori infection among children in Kuichong Subdistrict of Shenzhen City, China. PeerJ 2020; 8:e8878. [PMID: 32280567 PMCID: PMC7134012 DOI: 10.7717/peerj.8878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/09/2020] [Indexed: 11/21/2022] Open
Abstract
Background Helicobacter pylori infection is a significant burden to the public health in China as it can lead to various gastric diseases including peptic ulcers and gastric cancer. Since most infections occurred during childhood, it is therefore necessary to understand the prevalence and risk determinants of this bacterial infection in children. Herewith, we conducted a cross-sectional study in the Kuichong Subdistrict of Shenzhen City to assess the prevalence and risk factors of H. pylori infection among children. Methods From September 2018 to October 2018, 1,355 children aged 6–12 years from four primary schools in the Kuichong Subdistrict of Shenzhen City were recruited. These children were screened for H. pylori infection using the 13C-urea breath test. In addition, parents were requested to fill out a standardized questionnaire. The chi-square test and multivariable logistic regression analysis were used to identify risk factors for H. pylori. Results Among 1,355 children recruited in this study, 226 (16.7%; 95% CI [14.7–18.7]) were positive of H. pylori infection. Multivariable logistic regression analysis identified six factors significantly associated with H. pylori infection children including parent(s) with tertiary education level (OR: 0.64; 95% CI [0.46–0.89]), testing bottle feed temperature using the mouth (OR: 1.79; 95% CI [1.19–2.68]), sharing of cutlery between the feeding person and young children during meals (OR: 1.84; 95% CI [1.22–2.78]), eating fruit after peeling (OR: 2.56; 95% CI [1.4–4.71]), frequent dining out (OR: 3.13; 95% CI [1.46–6.68]) and snacking (OR: 1.43; 95% CI [1.01–2.01]). Conclusions Overall, better educated parent(s) played a protective role against the acquisition of H. pylori infection in children. Testing bottle feed temperature using the mouth, cutlery sharing between the feeding person and young children, and snacking posed a lower but significant risk for H. pylori infection. Only eating peeled fruits and frequent dining out were associated with greater infection risks.
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Affiliation(s)
- Jingjing Hu
- The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiangyu Wang
- The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Shenzhen Kuichong People's Hospital, Shenzhen, China
| | - Eng Guan Chua
- The Marshall Centre for Infectious Diseases Research and Training, University of Western Australia, Perth, WA, Australia
| | - Yongsheng He
- Shenzhen Kuichong People's Hospital, Shenzhen, China
| | - Qing Shu
- The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Li Zeng
- The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Shiyang Luo
- Shenzhen Kuichong People's Hospital, Shenzhen, China
| | - Barry J Marshall
- Shenzhen Kuichong People's Hospital, Shenzhen, China.,The Marshall Centre for Infectious Diseases Research and Training, University of Western Australia, Perth, WA, Australia
| | - Aijun Liu
- Shenzhen Kuichong People's Hospital, Shenzhen, China
| | - Chin Yen Tay
- Shenzhen Kuichong People's Hospital, Shenzhen, China.,The Marshall Centre for Infectious Diseases Research and Training, University of Western Australia, Perth, WA, Australia
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Luo H, Li C, He L, Wang Z, Xu RH. Artificial intelligence applications in upper gastrointestinal cancers - Authors' reply. Lancet Oncol 2020; 21:e5. [PMID: 31908307 DOI: 10.1016/s1470-2045(19)30809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Huiyan Luo
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Chaofeng Li
- Artificial Intelligence Laboratory, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Longjun He
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Zixian Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Rui-Hua Xu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
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11
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Wu Z, Cheng H, Shan F, Ying X, Miao R, Dong J, Sun Y, Xu A, Zhou Y, Wang Y, Chen L, Xue Y, Cao H, Hua Y, Xu Z, Zheng M, Yan M, Huang C, Suo J, Liang H, Fan L, Hu J, Hu X, Li G, Yu P, Li G, Shi Y, Luo H, Li Y, Xie M, Liu T, Zhang Z, Shi T, Li Z, Ji J. In-Hospital Mortality Risk Model of Gastric Cancer Surgery: Analysis of a Nationwide Institutional-Level Database With 94,277 Chinese Patients. Front Oncol 2019; 9:846. [PMID: 31632900 PMCID: PMC6779801 DOI: 10.3389/fonc.2019.00846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/19/2019] [Indexed: 02/05/2023] Open
Abstract
Background: The objective of this study is to identify independent risks and protective factors and to construct a mortality prediction model for gastrectomy in the Chinese population. Study design: This is a population-based prospective cohort at an institutional level. Seventy-two participating hospitals reported their annual gastrectomy data between 2014 and 2016, while 44 variables covering the institution and surgical information were included in the analysis. We used R software to encode and complete data pre-processing. The first difference model was applied to build the risk model. Data from 2014 and 2015 were assigned to risk model development, while data from 2016 was used for validation. Results: In the included centers with 94,277 gastric cancer cases, the in-hospital mortality rate was 0.32%. The regression model revealed that provinces with low-middle GDP, hospitals with annual gastrectomy volume between 100 and 500, greater volume of urgent surgeries performed, larger proportion of males, and a higher proportion of liver metastasis were independent risk factors for mortality following gastric surgeries, while higher laparoscopic resection volume, greater volume of distal gastrectomy with B2 reconstruction, and larger proportion of palliative surgery were independent protective factors (p < 0.05, respectively). In the prediction test, the mean square error of the training set was 0.948, while that of the test set was 0.728, demonstrating the effectiveness of this model. Conclusions: We constructed the first mortality risk prediction model for gastric cancer surgery in the Chinese population. The identified risk factors will help with the therapy selection, while further informing Chinese medical policy decision-makers.
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Affiliation(s)
- Zhouqiao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Huimin Cheng
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China
| | - Fei Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiangji Ying
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Rulin Miao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jianhong Dong
- Center of Minimally Invasive Gastrointestinal Surgery, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - Yihong Sun
- Department of General Surgery, Fudan University Zhongshan Hospital, Shanghai, China
| | - Aman Xu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yanbing Zhou
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yanong Wang
- Department of Gastric Cancer and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Hospital, Shanghai, China
| | - Lin Chen
- Department of General Surgery, People's Liberation Army General Hospital, People's Liberation Army (PLA) Army General Hospital, Beijing, China
| | - Yingwei Xue
- Department of General Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hui Cao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yawei Hua
- Department of General Surgery, Henan Cancer Hospital, Zhengzhou, China
| | - Zekuan Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Yan
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Changming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian Suo
- Department of Gastric Surgery, The First Hospital of Jilin University, Changchun, China
| | - Han Liang
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Lin Fan
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong Hospital, Xi'an, China
| | - Jiankun Hu
- Department of Gastrointestinal Surgery, West China Hospital, Chengdu, China
| | - Xiang Hu
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guoli Li
- Department of Gastrointestinal Surgery, Nanjing General Hospital, Nanjing, China
| | - Peiwu Yu
- Department of General Surgery, The First Hospital Affiliated Hospital to Army Medical University (AMU) (Southwest Hospital), Chongqing, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Guangzhou, China
| | - Yiran Shi
- Department of General Surgery, Weifang People's Hospital, Weifang, China
| | - Huayou Luo
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yong Li
- Department of General Surgery, Guangdong General Hospital, Guangzhou, China
| | - Ming Xie
- Department of General Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guangzhou, China
| | - Tianxue Liu
- Department of General Surgery, Penglai People's Hospital, Penglai, China
| | - Zhongyuan Zhang
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China
| | - Ting Shi
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Ziyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jiafu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
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Yin X, Xu Y, Man X, Liu L, Jiang Y, Zhao L, Cheng W. Direct costs of both inpatient and outpatient care for all type cancers: The evidence from Beijing, China. Cancer Med 2019; 8:3250-3260. [PMID: 31062522 PMCID: PMC6558587 DOI: 10.1002/cam4.2184] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/28/2019] [Indexed: 12/14/2022] Open
Abstract
Background Cancer is a major public health issue worldwide. The cost of cancer care imposes a substantial economic burden on society and patient, but it has not been thoroughly studied in China. This study aimed to describe direct cost and cost elements of all cancer types by different beneficial characteristics. Methods The research was a retrospective observational study based on inpatient and outpatient records with a primary diagnosis of cancer from 31 hospitals in 2016. Total cost and cost per time were analyzed by cancer type, sources (prescription medicines, consumables fee for diagnosis and surgery, and other health services), and beneficial characteristics (gender and age). Results A total of 30 224 eligible inpatient admissions and 485 391 outpatient visits were identified during the study period. Inpatient care costs account for 58.6% cancer treatment costs. Nearly 70% of the total expenditure is spent on patients aged 50‐79 years. Lung cancer had the highest economic cost (15% of overall cancer costs), followed by breast cancer (12%), and colorectal cancer (10%). Anticancer drug cost accounted a large proportion in both inpatient (37.7%) and outpatient care (64.6%). The average cost per inpatient admission was estimated to be $4590.1 (5621.9), ranging from $1157.7 (1349.8) for testis cancer to $7975 (7343.9) for stomach cancer. The regression analyses revealed that length of hospital stay, cancer type, age, payment type, and hospital level were highly correlated with the expenditure per admission (P < 0.001). Conclusions The cancer care cost is substantial and varies with cancer type. Our findings provide important information for health service planning, allowing more efficient allocation of health resources for the care of people with cancer.
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Affiliation(s)
- Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,College of Administration, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Xu
- College of Administration, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaowei Man
- College of Administration, Beijing University of Chinese Medicine, Beijing, China
| | - Liming Liu
- College of Administration, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Jiang
- College of Administration, Beijing University of Chinese Medicine, Beijing, China
| | - Liying Zhao
- College of Administration, Beijing University of Chinese Medicine, Beijing, China
| | - Wei Cheng
- College of Administration, Beijing University of Chinese Medicine, Beijing, China
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