Preplanned Studies: Economic Burden of Malignant Tumors — Yichang City, Hubei Province, China, 2019

Economic burden of disease is the economic loss of patients, families, and society caused by morbidity, disability, and premature death, as well as the consumption of health resources from disease prevention and treatment (1-2). Domestic and foreign studies show that the morbidity and mortality of malignant tumors have increased year by year (3), which brings heavy economic burden to the world. For example, economic burden of malignant tumors in Spain was 39.61 million CNY in 2015 (4), and economic burden of malignant tumors of a region in Southwest China was 18.86 billion CNY in 2016 (5). In this study, data from the cause of death surveillance, tumor registration, and big data platform of health management in Yichang City were used to calculate the direct medical burden of 14 types of malignant tumors and to estimate indirect economic burden by human capital method. The results showed that direct medical burdens of lung cancer, liver cancer, and colorectal carcinoma in 2019 were higher than those of other malignant tumors, being 561.67 million CNY, 386.08 million CNY, and 177.49 million CNY, respectively; indirect economic burdens of lung cancer, liver cancer, and esophageal cancer were also higher, being 326.49 million CNY, 188.17 million CNY, and 66.03 million CNY, respectively. Therefore, the economic burden of lung cancer, liver cancer, colorectal carcinoma, and esophageal cancer was significant, and these cancers should be the focus of disease prevention and control in Yichang City.

In this study, cancer mortality was derived from the cause of death surveillance that covers all 9 counties and 5 districts in Yichang. Cancer incidence was obtained from the tumor registration that includes 5 districts and 2 counties. Outpatient and inpatient diagnostic data and expense data of malignant tumors were gained from the big data platform of health management that contains medical information from all hospitals in 5 districts and 2 counties in Yichang. Yichang’s population data and per-capita GDP (per-capita Gross Domestic Product) from the statistical yearbook were employed to estimate direct medical burden and indirect economic burden of 14 types of malignant tumors for the year of 2019 in Yichang.

The 2019 outpatient and inpatient diagnostic databases from the big data platform of health management were linked with the expense database by unique personal identification number to get annual average medical cost of a patient for the year 2019. Items of medical cost include western medicine fee, Chinese herbal medicine fee, Chinese patent medicine fee, radiation fee, laboratory fee, examination fee, radiography fee, operation fee, blood transfusion fee, oxygen delivery fee, diagnosis fee, treatment fee, bed companion fee, nursing fee, hospitalization fee, bed fee, registration fee, material fee, and others. The following formula was applied to calculate direct medical burden for a cancer.

This study analyzed the median, smaller fourth quartile, and higher fourth quantile of the direct medical burden of 14 malignant tumors. The 2019 values of prevalence rate and number of populations in Yichang were taken for the above calculation. The calculation of prevalence rate of a cancer was illustrated in the calculation of years lived with disability (YLDs).

A human capital method was employed to estimate indirect economic burden of a malignant tumor for the year of 2019 in Yichang. The disability-adjusted life years (DALYs) and productivity weight were combined to estimate indirect economic burden. The formula is shown below.

Through consulting relevant literature on economic burden research, several assumptions were made. The contribution of different age groups to production was different, so the productivity weight was different by age group and their values were set at 0.15, 0.75, 0.80, and 0.1 for 0–14, 15–44, 45–59, and 60 years old and above, respectively, and the productivity weight of the overall population was 0.5 (6-8). The per-capita GDP of Yichang was 11,410.52 CNY for all age groups. The four age groups were applied for the above calculation and were then summed to obtain indirect economic burden of a cancer. The DALYs for the four age groups were estimated as follows.

After adjusting for missing report rate and garbage codes, the mortality rate of malignant tumors by age group for the year 2019 in Yichang was estimated. The years of life lost (YLLs) caused by early death of a malignant tumor were further calculated.

D was the number of deaths by age group, L was the life loss value by age group from the standard life expectancy table of the GBD 2013.

The YLDs caused by cancer disability were estimated by the following formula.

P was the prevalence by age group; DW was the disability weight that reflected the severity of disability caused by disease, and its value was between 0 and 1, in which 0 represents complete health and 1 represents death (9). Hereby, the value of disability weight for all 14 types of cancers was 0.451 as estimated from the GBD 2013. A five-year period was utilized for calculating the cancer prevalence of 2019, therefore the above number of prevalence was accumulated from 2015 to 2019.

The incidence data of malignant tumor surveillance in Yichang from 2015 to 2018 were obtained, but the incidence data of malignant tumors in 2019 were lacking. Therefore, this study needed to estimate the incidence of malignant tumors in 2019 first, and then the incidence data and prevalence rate of malignant tumors in 2019, and further estimate the YLDs of malignant tumors.

The specific estimation process was as follows. First, a linear model was established based on the incidence of cancer in counties and cancer types in tumor registration regions from 2015 to 2018 to estimate the incidence of malignant tumors in 2019. Second, the number of deaths of patients with new malignant tumors in 2019 was estimated based on the proportion of deaths and incidence of cancer types and counties in tumor registration regions from 2015 to 2018, combined with the incidence of malignant tumors in 2019. Then, according to the number of cancer incidence and death from 2015 to 2019, the number and prevalence of malignant tumors in 2019 were calculated. Finally, the YLDs of malignant tumors in Yichang in 2019 were estimated according to the above formula.

The DALYs of malignant tumors were estimated using the following formula.

In short, the above estimation was applied to each type of cancer. YLDs were estimated as the product of an estimate of prevalence and a disability weight for the cancer; YLLs were expressed as the product of mortality estimates and years of life lost due to premature death; and DALYs were calculated as the sum of YLLs and YLDs. All statistical analyses were performed using SAS (version 9.4, SAS Institute Inc., Cary, USA).

The results showed that the top five malignant tumors of medical cost per patient for the year 2019 in Yichang were pancreatic cancer, cerebral cancer, liver cancer, esophageal cancer, and lung cancer, which were 15,670 CNY, 12,136 CNY, 11,744 CNY, 11,474 CNY, and 10,144 CNY, respectively. The results were shown in Table 1.

From Table 2, the direct medical burdens of lung cancer, liver cancer, colorectal carcinoma, esophageal cancer, and breast cancer were ranked top five for direct medical burden, which were 561.67 million CNY, 386.08 million CNY, 177.49 million CNY, 151.80 million CNY, and 1,113.45 million CNY, respectively.

Table 3 showed that the indirect economic burdens of lung cancer, liver cancer, esophageal cancer, colorectal carcinoma, and gastric cancer in Yichang were higher than those of other malignant tumors, which were 326.49 million CNY, 188.17 million CNY, 66.03 million CNY, 57.30 million CNY, and 39.86 million CNY, respectively. The indirect economic burden of malignant tumors varied greatly by age group, of those, the indirect economic burden of 45–59 years old group was among the highest, 15–44 years old group was the second.