Analyzing Treatment Costs for Esophageal Cancer Patients At Different Stages
Chih-Cheng Hsieh*1, Ching-Wen Chien2
1Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; 2Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
Background: Esophageal cancer (EC) is a complex disease. Poor treatment results and high medical expense make it unpopular in cost-effectiveness analyses. At present, the main treatment for EC is surgical or non-surgical treatment. The aim of this study is to compare relative performance in terms of survival time and medical expenses of the 2 treatments for EC patients at different stages. This Result can be used to assist clinical decision making. Materials and
Methods: Charge & clinical data of 356 EC patients treated between 2000/1 to 2003/6 were collected. Patients were divided into 2 groups—surgical & non-surgical groups. Survival time, total expense, expense per month and relative expense performance index (REPI) for 2 treatments were calculated and compared between patients at different stages.
Results: The survival time and total expense in surgical group were longer and higher than in non-surgical treatment at all stages. Expense per month of EC patients at stage I, II & III were not significantly different between 2 groups. The expense per month in surgical group is significantly more than non-surgical group only for patients at stage IV. The REPI for patients at stage III was the highest and for patients at stage IV was lowest among four stages.
Conclusions: From the perspective of survival time and REPI, patients at early stage of EC, even stage III, surgical treatment was a better treatment than non-surgical treatment. But, for EC patients at stage IV, surgical treatment has a low REPI which suggests that surgical treatment may need further evaluation if medical expenses were included in clinical consideration.
| Stage | Variable | Surgical group | Non-surgical group | p value |
| I | Survival time (mo) | 47.4 | 14.7 | 0.002 |
| Total expense* | 23216 | 9564 | 0.021 | |
| Expense per month* | 919 | 822 | 0.773 | |
| REPI** | 2.882 | |||
| II | Survival time (mo) | 37.0 | 23.0 | 0.035 |
| Total expense | 25200 | 11420 | <0.001 | |
| Expense per month | 2266 | 1332 | 0.243 | |
| REPI | 0.946 | |||
| III | Survival time (mo) | 23.0 | 12.9 | <0.001 |
| Total expense | 24694 | 11676 | <0.001 | |
| Expense per month | 2373 | 1965 | 0.408 | |
| REPI | 1.476 | |||
| IV | Survival time (mo) | 13.8 | 8.6 | <0.001 |
| Total expense | 22873 | 12352 | <0.001 | |
| Expense per month | 5000 | 2414 | 0.004 | |
| REPI | 0.775 | |||
*Total expense and expense per month were calculated within 3 years after diagnosis in USD
**REPI was calculated by the ratio of survival time benefit divided by the ratio of expense per month
