To establish the direct, costs of the process of diagnosing lung cancer in 2003. As a secondary objective, the cost of admissions defined as inappropriate was evaluated.
Material and MethodsA prospective cohort study of lung cancer, cases diagnosed in 2003 was performed. Diagnosis was based on cytohistology or clinical and radiological criteria. the total cost was determined according to Decree 222/2003, governing Galician health service rates. A distinction was drawn between hospitalized patients and outpatients, and between small cell and non-small cell carcinomas. Inappropriate admissions were analyzed in accordance with the criteria established by our study team, and the savings that would have been made had these patients been treated as outpatients were calculated. the statistical analyses were performed using SPSS version 10.0.
ResultsA total of 160 patients were diagnosed with lung cancer; 76 (47.5%) of these were outpatients, and the remaining 84 (52.5%) were hospitalized patients. Admissions were considered inappropriate in 27 cases. of the total of 160 patients, 108 were diagnosed as having non-small cell carcinomas, and 38 as having small cell carcinomas; the remaining 14 patients were diagnosed on the basis of clinical-radiological criteria. Total cost was €742847 (mean. €4643; 95% confidence interval, €4049€5236), composed of €552614 (mean, €6579) for admitted patients, and €190 233 (mean, €2503) for outpatients. Mean cost was €3692 for the small cell carcinomas, and €5070 for the non-small cell carcinomas. Comparing limited and extensive small cell carcinomas, the mean cost for the former was significantly lower than for the latter (€1894 compared to €4098); there was also a lower mean cost for early compared to advanced stages of non-small cell carcinomas (€3660 compared to €5494). the savings to be made from unnecessary admissions were calculated at €120258.
ConclusionsThe mean cost for outpatient lung cancer treatment was 62% lower than for hospitalization. Non-small cell carcinomas were more costly on average than small cell carcinomas, and advanced stages of the small cell carcinomas involved a higher average cost than the initial stages of the disease. For our series, the savings to be made from unnecessary admissions were calculated at €120258.
Conocer los costes directos del proceso de diagnóstico del cáncer de pulmón (CP) en el año 2003. Como objetivo secundario se evaluó el coste asociado a los ingresos definidos como inadecuados.
Material y MétodosSe ha Ilevado a cabo un estudio de una cohorte prospectiva de casos de CP diagnosticado durante el año 2003 mediante citohistología o por criterios clinicorradiológicos. Se determinó el coste total, segün Decreto 222/2003 de Tarifas de los Servicios Sanitarios de Galicia, diferenciando entre pacientes ingresados Y ambulatorios, Y entre carcinoma microcítico Y no microcítico. Asimismo, se analizaron los ingresos inapropiados, según criterios establecidos por nuestro grupo, Y se estimó el ahorro que supondría haberlos manejado de forma ambulatoria. Para el análisis estadístico se utilizó el programa estadístico SPSS 10.0.
ResultadosSe diagnosticó de CP a 160 pacientes, 76 (47,5%) de forma ambulatoria Y 84 (52,5%) mediante ingreso. Éste se consideró inapropiado en 27. El diagnóstico fue de carcinoma no microcítico en 108 pacientes Y microcítico en 38, Y en 14 se estableció por criterios clinicorradiológicos. El coste total fue de 742.847 € (media: 4.643 €; intervalo de confianza del 95%, 4.0495.236), de 552.614 € (media: 6.579 €) en los ingresados Y de 190.233 € (media: 2.503 €) en los ambulatorios. El coste medio en los carcinomas microcíticos fue de 3.692 € Y en los no microcíticos de 5.070 €. En los primeros, el coste medio en la enfermedad limitada fue significativamente menor que en la enfermedad extendida (1.894 frente a 4.098 €), Y en los segundos el coste medio en los estadios iniciales también fue significativamente menor que en los avanzados (3.660 frente a 5.494 €). El ahorro estimado por ingresos inapropiados sería de 120.258 €.
ConclusionesEl coste medio del paciente con manejo ambulatorio es un 62% inferior al que ocasiona el ingresado. El coste medio en el carcinoma no microcítico Y que en el microcítico, Y el de los estadios avanzados, mayor que el de los iniciales. En nuestra serie, el ahorro estimado por ingresos inapropiados sería de 120.258 € por año.
