Zdravstvena ekonomija karcinoma dojke u Vojvodini

Abstract

Uvod: Karcinom dojke je najčešći maligni tumor kod žena, kako u svetu, tako i u Srbiji. Naša zemlja zauzima prvo mesto u Evropi prema stopi mortaliteta. Pored efikasnosti i bezbednosti terapije, važno je staviti akcenat i na troškove lečenja, kao i na kvalitet života obolelih. Ciljevi: Opšti cilj istraživanja je bio pružiti nove informacije o zdravstvenoj ekonomiji karcinoma dojke u Vojvodini i doprineti optimalnoj alokaciji ograničenih resursa zdravstvenog sistema. Specifični ciljevi su bili procena ukupnih troškova karcinoma dojke u Vojvodini u 2019. godini, odnos direktnih i indirektnih troškova i procena troškova i kvaliteta života u različitim stadijumima karcinoma dojke. Materijal i metode: Istraživanje je realizovano kao retrospektivno-prospektivna jednogodišnja studija troškova bolesti. U prvom, retrospektivnom delu istraživanja, procenjeni su ukupni troškovi karcinoma dojke u Vojvodini u 2019. godini, koji su obuhvatili direktne i indirektne troškove. Troškovi su sagledani iz društvene perspektive, bazirani na prevalenciji bolesti. Drugi deo istraživanja je bio prospektivni deo koji je obuhvatio 175 pacijentkinja, podeljene u tri međusobno isključive grupe, u kom je izvršena procena troškova i kvaliteta života povezanog sa zdravljem u različitim stadijumima karcinoma dojke. U tu svrhu korišćeni su socio-demografski upitnik i EQ-5D-3L standardizovan upitnik. Rezultati: Ukupni troškovi karcinoma dojke su procenjeni na 15 miliona evra (0,12% BDP-a). Indirektni troškova su činili 66,3% ukupnih troškova, a najveći udeo su imali troškovi prevremene penzije, koji su procenjeni na 4,96 miliona evra. Troškovi bolničkog lečenja su imali najveći udeo u direktnim troškovima i procenjeni su na 3,84 miliona evra. Prosečni troškovi karcinoma dojke su procenjeni na 17.428 evra po pacijentkinji, a najviši su bili u grupi pacijentkinja sa metastatskom bolesti (27.117 evra). Kvalitet života povezan sa zdravljem je najviše bio narušen u metastatskom stadijumu bolesti, u kojem je EQ-5D-3L indeks iznosio 0,646 (p < 0,001). Zaključak: Karcinom dojke predstavlja veliko finansijsko opterećenje kako za zdravstveni sistem, tako i za društvo, posebno u metastatskoj fazi bolesti. Strategije prevencije i ranog otkrivanja karcinoma dojke trebalo bi da budu prioritet u alokaciji sredstava, čime bi se doprinelo smanjenju troškova bolesti i poboljšanju kvaliteta života.

Introduction: Breast cancer is the most common malignant tumor in women, both in the world and in Serbia. Our country ranks first in Europe in terms of mortality rate. In addition to the effectiveness and safety of therapy, it is important to put emphasis on the cost of treatment, as well as on the quality of life of patients. Objectives: The overall objective of this research was to provide new information on the health economy of breast cancer in Vojvodina and contribute to the optimal allocation of limited resources of the health system. The specific objectives were to estimate the total cost of breast cancer in Vojvodina in 2019, the ratio of direct and indirect costs, and costs and quality of life in different stages of breast cancer. Materials and methods: The research was conducted as a retrospective-prospective one-year cost of illness study. In the first, retrospective part of the research, the total cost of breast cancer in Vojvodina in 2019 was estimated, which included direct and indirect costs. Costs were estimated from a social perspective, based on the prevalence of the disease. The second part of the study was a prospective part that included 175 patients, divided into three mutually exclusive groups, in which the cost and health related quality of life in different stages of breast cancer were assessed. For this purpose, socio-demographic questionnaire and the EQ-5D-3L standardized questionnaire were used. Results: The total cost of breast cancer was estimated at 15 million EUR (0.12% GDP). Indirect costs accounted for 66.3% of the total cost, with the productivity losses due to premature retirement as a main cost driver (4.96 million EUR). The cost of hospitalisation was the main cost driver for direct costs (3.84 million EUR). The average cost of breast cancer was estimated at 17,428 EUR per patient, and the highest cost was in the group of patients with metastatic disease (27,117 EUR). Patients with metastatic disease reported the lowest HRQoL values, and had a mean EQ-5D-3L index value of 0.646 (p < 0.001). Conclusion: Breast cancer is a huge financial burden on both the health system and society, especially in the metastatic stage. Strategies for the prevention and early detection of breast cancer should be a priority in allocating funds, which would contribute to reducing the cost of illness and improving the quality of life.