Provider cost of treating oral potentially malignant disorders and oral cancer in Malaysian public hospitals

Cost-consequence analysis of surgical and clinical treatment modalities of laryngeal cancer

BACKGROUND

Laryngeal Squamous Cell Carcinoma (LSCC) may be treated clinically or surgically as a therapeutic option with a curative intention. The aim of this study is to compare direct medical costs and overall survival associated with the treatment of LSCC.

METHODS

Retrospective cost-consequence analysis, from the perspective of a Brazilian public hospital that included patients with LSCC, from 2014 to 2017. Unit costs were estimated using a macro-costing approach. The Propensity Score Matching method was used. Survival analyses were performed using the Kaplan-Meier method.

RESULTS

The therapeutic modalities were similar in terms of total costs: USD 32,259.65 for the clinical group and USD 34,385.87 for the surgical group (p = 0.215). Patients in the surgical group showed better overall survival than the clinical group (HR 0.53; p = 0.047).

CONCLUSION

Both therapeutic modalities for the treatment of LSCC showed similar total costs. Nevertheless, overall survival was better in the surgical group.

Path analysis of factors influencing length of stay and hospitalisation expenses for oral cancer patients in tertiary hospitals in southeastern China: a cross-sectional study

AIMS

To investigate the associations between influencing factors with length of stay (LOS) and hospitalisation expenses in oral cancer (OC) patients, and to explore the potential pathways through which these factors influence hospitalisation expenses using path analysis.

DESIGN

Cross-sectional.

SETTING

A comprehensive tertiary hospital in southeastern China.

PARTICIPANTS

A total of 810 patients with histologically confirmed primary OC admitted to the First Affiliated Hospital of Fujian Medical University, Fujian Province, between 2015 and 2020.

MAIN OUTCOME MEASURES

LOS and hospitalisation expenses for OC patients.

RESULTS

The median hospitalisation expenses and LOS for OC patients in southeastern China were substantial, amounting to $6330 and 29 days, respectively. Treatment and surgery fees constituted the largest proportion of total expenses (28.59%), followed by inspection and laboratory test fees (20.63%), comprehensive medical service fees (19.27%), drug fees (18.09%) and medical consumables fees (11.69%). LOS was significantly associated with tumour site, surgery and chemotherapy. Factors such as longer LOS, poor oral hygiene, advanced tumour stage (II-IV), larger tumour size (>2 cm3), surgery and bilateral neck dissection were strongly linked to higher hospitalisation expenses. Path analysis revealed that neck dissection had the highest total effect on hospitalisation expenses (β=0.307), while surgery exerted an indirect effect on expenses via LOS (β=0.021).

CONCLUSION

This study highlights the significant economic burden imposed by OC on patients and healthcare systems. While prevention and early diagnosis remain critical, our findings underscore several modifiable factors, including improving oral hygiene and optimising surgical protocols, such as chemotherapy and lymph node dissection, that present opportunities to reduce costs and enhance cost-effectiveness. These insights provide actionable targets for mitigating financial burdens and improving patient outcomes.

Estimating the direct costs of oral cancer in Spain: a retrospective hospital data analysis

BACKGROUND

Studies on the costs incurred from cancer in Spain are scarce and have focused on the most prevalent types such as colorectal, breast, and lung cancer. The aim of this study was to calculate the direct costs associated with the diagnostic, treatment and follow-up procedures for oral cancer in Spain.

MATERIAL AND METHODS

Applying a bottom-up approach, we retrospectively analyzed the medical records of a cohort of 200 patients with oral cancer (C00-C10), diagnosed and treated in Spain between 2015 and 2017. For each patient, we collected their age, sex, degree of medical impairment (American Society of Anesthesiologists [ASA] classification), tumor extent (TNM classification), relapses and survival during the first 2 years of follow-up. The final calculation of the costs is expressed in absolute values in euros as the percentage of the gross domestic product per capita and in international dollars (I$).

RESULTS

The total cost per patient rose to €16,620 (IQR, €13,726; I$11,634), and the total direct cost at the national level was €136,084,560 (I$95,259,192). The mean cost for oral cancer represented 65.1% of the gross domestic product per capita. The costs for the diagnostic and therapeutic procedures were determined by the ASA grade, tumor size, lymph node infiltration and presence of metastases.

CONCLUSIONS

The direct costs for oral cancer are considerable compared with other types of cancer. In terms of gross domestic product, the costs were similar to those of countries neighboring Spain, such as Italy and Greece. The main determinants of this economic burden were the patient's degree of medical impairment and tumor extent.

Financial burden of heart failure in Malaysia: A perspective from the public healthcare system

BACKGROUND

Estimating and evaluating the economic burden of HF and its impact on the public healthcare system is necessary for devising improved treatment plans in the future. The present study aimed to determine the economic impact of HF on the public healthcare system.

METHOD

The annual cost of HF per patient was estimated using unweighted average and inverse probability weighting (IPW). Unweight average estimated the annual cost by considering all observed cases regardless of the availability of all the cost data, while IPW calculated the cost by weighting against inverse probability. The economic burden of HF was estimated for different HF phenotypes and age categories at the population level from the public healthcare system perspective.

RESULTS

The mean (standard deviation) annual costs per patient calculated using unweighted average and IPW were USD 5,123 (USD 3,262) and USD 5,217 (USD 3,317), respectively. The cost of HF estimated using two different approaches did not differ significantly (p = 0.865). The estimated cost burden of HF in Malaysia was USD 481.9 million (range: USD 31.7 million- 1,213.2 million) per year, which accounts for 1.05% (range: 0.07%-2.66%) of total health expenditure in 2021. The cost of managing patients with heart failure with reduced ejection fraction (HFrEF) accounted for 61.1% of the total financial burden of HF in Malaysia. The annual cost burden increased from USD 2.8 million for patients aged 20-29 to USD 142.1 million for those aged 60-69. The cost of managing HF in patients aged 50-79 years contributed 74.1% of the total financial burden of HF in Malaysia.

CONCLUSION

A large portion of the financial burden of HF in Malaysia is driven by inpatient costs and HFrEF patients. Long-term survival of HF patients leads to an increase in the prevalence of HF, inevitably increasing the financial burden of HF.

Time-to-Treatment of Oral Cancer and Potentially Malignant Oral Disorders: Findings in Malaysian Public Healthcare

This study aims to evaluate the time-to-treatment of oral cancer and potentially malignant oral disorders (PMOD) in a Malaysian public healthcare setting while exploring its contributing factors. It consists of (1) a cross-sectional patient survey to quantify time to seek care and barriers faced, and (2) a retrospective medical record abstraction to determine treatment and management intervals. Time intervals were aggregated and analyzed by their primary contributor—patient, professional, or healthcare system. The average total time-to-treatment of the 104 patients investigated was 167 days (SD = 158). This was predominantly contributed by the patient interval of 120 days (SD = 152). In total, 67.0% of patients delayed their visit to primary healthcare centers because they assumed the lesions were not dangerous or of concern. Additionally, there was a significant difference between patients ‘facing’ and ‘not facing’ difficulties to seek care, at 157 vs. 103 days (p = 0.028). System and professional delays were comparably shorter, at 33 days (SD = 20) and 10 days (SD = 15) respectively. Both demonstrated a significant difference between oral cancer and PMOD, at 43 vs. 29 days (p < 0.001) and 5 vs. 17 days (p < 0.001). The findings reiterate the need to reform current initiatives to better promote early lesion recognition by patients and implement strategies for the elimination of their access barriers.

Outpatient Dental Treatment Expenditure for Patients with Oromaxillofacial Cancer: A Cohort Study in Taiwan

The information on the outpatient expenditure of patients with oromaxillofacial cancer is minimal. This study aimed to compare the average annual expenditure on dental treatment for these patients 5 years before and 5 years after oromaxillofacial cancer diagnosis. In this study, 7731 patients who received oromaxillofacial cancer diagnosis in 2005 were selected from the Registry of Catastrophic Illness Database as the case-cohort. In the control cohort, 38,655 people without cancer were selected from the National Health Insurance Research Database, with the case–control ratio being 1:5. All participants were observed for 5 years before diagnosis and 5 years after diagnosis. The conditional logistic regression model was used to determine the odds ratios of annual expenditures incurred by participants in the case-cohort. The measurement results indicated that in the oromaxillofacial cancer cohort, the average annual dental expenditure levels at 1, 2, 3, 4, and 5 years after diagnosis were US $97.34, US $77.23, US $109.65, US $128.43, and US $128.03 and those at these years before diagnosis were US $37.52, US $32.10, US $31.86, US $29.14, and US $29.35, respectively. In conclusion, the average annual expenditure on the dental treatment of oromaxillofacial cancer patients after five years of diagnosis was increased compared to five years before diagnosis.