대장암 환자가 부담하는 직접비용: 2년간의 추적조사를 통해 = Cost of Colorectal Cancer Care in Korea: A Prospective Group Study with a 2-year Follow-up

다국어 초록 (Multilingual Abstract)

Received February 1, 2008, Accepted September 11, 2008
Correspondence to: Jae-Gahb Park, Cancer Research Institute and Cancer Research Center, Seoul National University, 28, Yeongeon- dong, Jongo-gu, Seoul 110-744, KoreaTel: [phone], Fax: [phone]E-mail: [e-mail] of Colorectal Cancer Care in Korea: A Prospective Group Study with a 2-year Follow-up
National Cancer Control Research Institute, 1Research Institute and Hospital, National Cancer Center, Goyang, Korea
Kui Son Choi, Eun-Cheol Park, Min-Kyung Lim, Jin-Hwa Lim, Sung-Gyeong Kim, Jae Hyun Park, Seung-Yong Jeong1, Ji Won Park1, Seok-Byung Lim1, Hyo Seong Choi1, Kyung Hae Jung1, Dae Yong Kim1, Jae-Gahb Park1Purpose: The incidence of cancer incidence and the rate of mortality are increasing in Korea. Specifically, colorectal cancer in men is one of the most sharply increasing malignancies. The objective of this study was to assess the direct costs for colorectal cancer patients and to identify the factors that influence cancer costs. Methods: The direct costs of colorectal cancer were examined with a prospective group study at a hospital. The direct costs were assessed every 3 months over a 24-month period through patient interviews, medical records, and claims data. We identified the major factors associated with the cost of colorectal cancer by using a general linear model for the log-transformed data. Results: The group was comprised of 100 patients with colon cancer and 120 patients with rectal cancer. The average costs per patient during the first and the second years after diagnosis were ￦16,280,000 and ￦5,786,000, respectively. Medical costs accounted for about 68% (￦11,090,000) of the first year’s total cost and about 62% (￦3,602,000) of the second year’s total cost. National Health Insurance (NHI) paid approximately 50% of the total medical cost. The total cost of colorectal cancer was clearly associated with the stage of the disease at first diagnosis, the cancer site, therapeutic modalities, and recurrence. Conclusions: These results indicate that colorectal cancer has a heavy financial impact on cancer patients. The total cost of colorectal cancer is clearly associated with the stage of the disease at first diagnosis. Increased efforts in terms of prevention and early detection may assist in reducing the costs.

국문 초록 (Abstract)

목적: 암 발생과 사망이 증가하고 있으며, 특히 남성에서 대장암 발생이 급격하게 증가하고 있다. 본 연구는 대장암 환자가 부담하는 직접비용을 추정하고, 이에 영향을 미치는 요인을 분석하였다. 방법: 일개 병원 대장암센터에 내원하여 대장암으로 치료받은 220명을 2년간 추적조사 하였다. 직접비용은 3개월마다 환자와의 인터뷰, 의료비 청구자료, 의무기록조사로 추계하였다. 로그치환된 선형회귀분석으로 직접비용에 영향을 미치는 요인을 파악하였다. 결과: 220명의 대장암 환자 중 100명은 결장암, 120명은 직장암이었다. 대장암 환자의 진단후 1년간 지출한 직접비용은 16,280,000원이었으며, 2년째 비용은 5,786,000원이었다. 이중 의료비가 62∼68%를 차지하였으며, 의료비 중 보험자 부담금은 50%였다. 환자의 진단 당시 병기, 위치, 치료유형, 재발 여부가 직접비용에 통계적으로 유의하게 영향을 미쳤다. 결론: 대장암 환자의 진단 후 1년간 직접비용은 16,280,000원으로 환자의 경제적 부담이 큰 것으로 조사되었다. 그러나 조기 대장암은 진행암에 비해 2배 이상 직접비용이 감소하였다.

참고문헌 (Reference)

• 1 Taplin SH, "Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care" 587 : 417-426, 1995
• 2 Redaelli A, "Screening, prevention and socioeconomic costs associated with the treatment of colorectal cancer" 21 : 1213-1238, 2003
• 3 Whynes DK, "Screening and the costs of treating colorectal cancer" 68 : 965-968, 1993
• 4 Penberthy L, "Predictors of Medicare costs in elderly beneficiaries with breast, colorectal, lung, or prostate cancer" 2 : 149-160, 1999
• 5 Brown ML, "Obtaining long-term disease specific costs of care: application to Medicare enrollees diagnosed with colorectal cancer" 37 : 1249-1259, 1999
• 6 Shin HR, "Nationwide cancer incidence in Korea, 1999- 2001; First result using the National Cancer Incidence Data-base" 37 : 325-331, 2005
• 7 "National Statistical Office. Korean Statistical Information System. Daejeon: National Statistical Office; c2006 [cited 2007 Dec 1]"
• 8 Riley GF, "Medicare payments from diagnosis to death for elderly cancer patients by stage at diagnosis" 40 : 104-117, 2002
• 9 Ramsey SD, "Lifetime cancer-attributable cost of care for long-term survivors of colorectal cancer" 97 : 440-445, 2002
• 10 Delco F, "Hospital health care resource utilization and costs of colorectal cancer during the first 3-year period following diagnosis in Switzerland" 21 : 615-622, 2005
• 11 O’Brien BD, "Estimation of hospital costs for colorectal cancer care in Nova Scotia" 15 : 43-47, 2001
• 12 Chang S, "Estimating the costs of cancer: results on the basis of claims data analyses for cancer patients diagnosed with seven types of cancer during 1999 to 2000" 22 : 3524-3530, 2000
• 13 Brown ML, "Estimating health care costs related to cancer treatment from SEER-Medicare data" 40 : 104-117, 2002
• 14 Wright GE, "Differences among the elderly in the treatment costs of colorectal cancer: how important is race?" 45 : 420-430, 2007
• 15 Fireman BH, "Cost of care for cancer in a health maintenance organization" 18 : 51-76, 1997
• 16 Lee JH, "Chronological changes of colorectal cancer" 33 : 51-57, 1999
• 17 Ramsey SD, "Cancer-attributable costs of diagnosis and care for persons with screen-detected versus symptom- detected colorectal cancer" 125 : 1645-1650, 2003