Economic Burden of Advanced-stage Gastric Cancer in Two Districts of Wuxi: A Health Economic Analysis

Abstract

Introduction: Gastric cancer remains one of the top 3 contributors to cancer inpatient payment from 2008 to 2017, with the total expenditure reaching 23.86 billion CNY in 2017. Among surgical-related treatments, gastric cancer patients faced the highest median total costs (USD 13,398). In China, previous studies have examined the economic burden of gastric cancer across various provinces or cities but have lacked a focus on cost disparities within a single city with a high disease burden. This study aims to explore the composition of healthcare expenditure, and the risk factors associated with the expenditure in two hospitals from different districts in Wuxi, a city with high gastric cancer incidence.Method: This study used a quantitative method. The quantitative data on advanced-stage gastric cancer was obtained from the IT Department of Wuxi People's Hospital and Wuxi Xishan People's Hospital. The quantitative data was designed to elucidate sociodemographic characteristics of the study population, compare the various costs in the two hospitals, and identify risk factors that contribute to total cost and out-of-pocket expenses. Results: In the quantitative analysis, a total of 90 patients are from Wuxi People's Hospital (Liangxi District), and 71 are from Wuxi Xishan People's Hospital (Xishan District). The overall medical cost of advanced-stage gastric cancer patients at Wuxi People's Hospital is higher than that at Wuxi Xishan People's Hospital, with this discrepancy achieving statistical significance (P<0.001). At Wuxi People's Hospital, employees had lower out-of-pocket expenses than residents (β = -0.205, P=0.013). Self-paying patients had significant higher out-of-pocket expenses. Robotic surgery increased total costs (β=0.040, P<0.001) and out-of-pocket expenses (β= 0.765, P<0.001), with patients paying 2.1 times more than those undergoing endoscopic surgery. Each additional hospital day increased total costs by 3.4% and out-of-pocket expenses by 2.4%. At Wuxi Xishan People's Hospital, Employees had lower out-of-pocket expenses (β=-0.271, P=0.013). Each additional hospital day increased total costs by 2.3% and out-of-pocket expenses by 1.7%. Conclusion: The results of this study show that hospitals should optimize the length of stay, improve rural insurance plans, promote early detection and prevention, and standardize inpatient costs using Diagnosis Related Groups (DRG) and Diagnosis Intervention Packet (DIP) to reduce medical costs. Health administrators should bridge the gap between employee and resident insurance coverage to make early cancer detection and treatment available to employees and residents.