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Estudio primario
Medwave 2016 Ago;16(7):e6509 doi: 10.5867/medwave.2016.07.6509
Impacto económico del cáncer en Chile: una medición de costo directo e indirecto en base a registros 2009
Assessing the economic impact of cancer in Chile: a direct and indirect cost measurement based on 2009 registries
Camilo Cid, Cristian Herrera, Rodrigo Rodríguez, Gabriel Bastías, Jorge Jiménez
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Palabras clave: neoplasms, cost of illness, costs, cost analysis

Abstract

PURPOSE
This paper aims to determine the economic impact that cancer represents to Chile, exploring the share of costs for the most important cancers and the differences between the public and private sector.

METHODS
We used the cost of illness methodology, through the assessment of the direct and indirect costs associated with cancer treatment. Data was obtained from 2009 registries of the Chilean Ministry of Health and the Superintendence of Health. Indirect costs were calculated by days of job absenteeism and potential years of life lost.

RESULTS
Over US$ 2.1 billion were spent on cancer in 2009, which represents almost 1% of Chile’s Gross Domestic Product. The direct per capita cost was US$ 47. Indirect costs were 1.92 times more than direct costs. The three types of cancer that embody the highest share of costs were gastric cancer (17.6%), breast cancer (7%) and prostate cancer (4.2%) in the public sector, and breast cancer (14%), lung cancer (7.5%) and prostate cancer (4.1%) in the private sector. On average men spent 30.33% more than women.

CONCLUSION
There are few studies of this kind in Chile and the region. The country can be classified as having a cancer economic impact below the average of those in European Union countries. We expect that this information can be used to develop access policies and resource allocation decision making, and as a first step into further cancer-costing studies in Chile and the Latin American and Caribbean region.


 
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PURPOSE
This paper aims to determine the economic impact that cancer represents to Chile, exploring the share of costs for the most important cancers and the differences between the public and private sector.

METHODS
We used the cost of illness methodology, through the assessment of the direct and indirect costs associated with cancer treatment. Data was obtained from 2009 registries of the Chilean Ministry of Health and the Superintendence of Health. Indirect costs were calculated by days of job absenteeism and potential years of life lost.

RESULTS
Over US$ 2.1 billion were spent on cancer in 2009, which represents almost 1% of Chile’s Gross Domestic Product. The direct per capita cost was US$ 47. Indirect costs were 1.92 times more than direct costs. The three types of cancer that embody the highest share of costs were gastric cancer (17.6%), breast cancer (7%) and prostate cancer (4.2%) in the public sector, and breast cancer (14%), lung cancer (7.5%) and prostate cancer (4.1%) in the private sector. On average men spent 30.33% more than women.

CONCLUSION
There are few studies of this kind in Chile and the region. The country can be classified as having a cancer economic impact below the average of those in European Union countries. We expect that this information can be used to develop access policies and resource allocation decision making, and as a first step into further cancer-costing studies in Chile and the Latin American and Caribbean region.

Autores: Camilo Cid[1], Cristian Herrera[1], Rodrigo Rodríguez[1], Gabriel Bastías[1], Jorge Jiménez[1]

Filiación:
[1] Departamento de Salud Pública, Escuela de Medicina, Universidad Católica de Chile, Santiago, Chile

E-mail: camilocid@gmail.com

Correspondencia a:
[1] Marcoleta 434
Santiago
Chile

Citación: Cid C, Herrera C, Rodríguez R, Bastías G, Jiménez J. Assessing the economic impact of cancer in Chile: a direct and indirect cost measurement based on 2009 registries. Medwave 2016 Ago;16(7):e6509 doi: 10.5867/medwave.2016.07.6509

Fecha de envío: 26/5/2016

Fecha de aceptación: 21/7/2016

Fecha de publicación: 2/8/2016

Origen: no solicitado

Tipo de revisión: con revisión por dos pares revisores externos, a doble ciego

Ficha PubMed

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  1. Szot Meza J. La transición demográfico-epidemiológica en Chile, 1960-2001. Rev Esp Salud Pública 2003 Sep-Oct;77(5):605-13. | Link |
  2. OMS. Cáncer. Nota descriptiva N°297. Febrero de 2015 who.int [on line]. | Link |
  3. Gobierno de Chile, Ministerio de Salud. Home page, Departamento de Estadísticas e Información en Salud (DEIS). deis.minsal.cl [on line] | Link |
  4. Gobierno de Chile, Ministerio de Salud. Objetivos Sanitarios de la década 2000-2010. Evaluación final del período. Grado de cumplimiento de objetivos de impacto. Santiago, Chile: MINSAL; 2010.
  5. Warren JL, Yabroff KR, Meekins A, Topor M, Lamont EB, Brown ML. Evaluation of trends in the cost of initial cancer treatment. J Natl Cancer Inst. 2008 Jun 18;100(12):888-97. | CrossRef | PubMed |
  6. Gobierno de Chile, Ministerio de Salud. Estudio de Carga de Enfermedad y Carga Atribuible. Santiango, Chile: MINSAL; 2007. | Link |
  7. Gobierno de Chile, Ministerio de Salud. lnforme Final. Estudio Costo-efectividad de Intervenciones en Salud. Santiago, Chile: MINSAL; Mayo 2010.
 | Link |
  8. Jiménez J. Mapa de la Investigación en Cáncer en Chile (Cancer Research Map Chile). Consorcio Tecnológico en Biomedicina Clínico-Molecular Aplicada (BMRC-Chile), Diciembre 2010.
  9. Drummond M. Cost-of-illness studies: a major headache? Pharmacoeconomics. 1992 Jul;2(1):1-4. | PubMed |
  10. World Health Organization. WHO guide to identifying the economic consequences of disease and injury. Department of Health Systems Financing, Health Systems and Services. Geneva, Switzerland: WHO;2009. | Link |
  11. Health at a Glance 2015. OECD Publications. oecd.org [on line]. | Link |
  12. World Health Organization. Global Health Observatory Data Repository. who.int [on line]. | Link |
  13. Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet. 2007 Dec 8;370(9603):1929-38. | PubMed |
  14. Liu JL, Maniadakis N, Gray A, Rayner M. The economic burden of coronary heart disease in the UK. Heart. 2002 Dec;88(6):597-603. | PubMed |
  15. Cohen JW, Krauss NA. Spending and service use among people with the fifteen most costly medical conditions, 1997. Health Aff; 2003:129-138.
  16. Druss BG, Marcus SC, Olfson M, Tanielian T, Elinson L, Pincus HA. Comparing the national economic burden of five chronic conditions. Health Aff (Millwood). 2001 Nov-Dec;20(6):233-41. | PubMed |
  17. Druss BG, Marcus SC, Olfson M, Pincus HA. The most expensive medical conditions in America. Health Aff (Millwood). 2002 Jul-Aug;21(4):105-11. | PubMed |
  18. American Heart Association. Heart disease and stroke statistics -2001 update. Dallas: American Heart Association; 2001.
  19. Russell MW, Huse DM, Drowns S, Hamel EC, Hartz SC. Direct medical costs of coronary artery disease in the United States. Am J Cardiol. 1998 May 1;81(9):1110-5. | PubMed |
  20. Currie CJ, Morgan CL, Peters JR. Patterns and costs of hospital care for coronary heart disease related and not related to diabetes. Heart. 1997 Dec;78(6):544-9. | PubMed |
  21. Heijink R, Noethen M, Renaud T, Koopmanschap M, Polder J. Cost of illness: an international comparison. Australia, Canada, France, Germany and The Netherlands. Health Policy. 2008 Oct;88(1):49-61. | CrossRef | PubMed |
  22. Haga K, Matsumoto K, Kitazawa T, Seto K, Fujita S, Hasegawa T. Cost of illness of the stomach cancer in Japan - a time trend and future projections. BMC Health Serv Res. 2013 Jul 23;13:283. | CrossRef | PubMed |
  23. Kriza C, Emmert M, Wahlster P, Niederländer C, Kolominsky-Rabas P. Cost of illness in colorectal cancer: an international review. Pharmacoeconomics. 2013 Jul;31(7):577-88. | CrossRef | PubMed |
  24. Sorensen SV, Goh JW, Pan F, Chen C, Yardley D, Martín M, et al. Incidence-based cost-of-illness model for metastatic breast cancer in the United States. Int J Technol Assess Health Care. 2012 Jan;28(1):12-21. | CrossRef | PubMed |
  25. Guy GP, Ekwueme DU. Years of potential life lost and indirect costs of melanoma and non-melanoma skin cancer: a systematic review of the literature. Pharmacoeconomics. 2011 Oct;29(10):863-74. | CrossRef | PubMed |
  26. Cooper BS, Rice DP. The economic cost of illness revisited. Social Security Bulletin. 1976;39:21-36. | Link |
  27. Rice DP, Hodgson TA, Kopstein AN. The economic costs of illness: a replication and update. Health Care Financ Rev. 1985 Fall;7(1):61-80. | PubMed |
  28. Bitrán R, Muñoz J, Navarrete M, Aguad P, Ubilla G. Equidad en el Financiamiento del Seguro Público de Salud: Informe Final. Santiago, Chile: MINSAL; 1996.
  29. Vargas V, Cid C, Matus M, Delgado I, Sánchez JM, Heyermann B, Angulo J. Una metodología para ajustar y compensar las diferencias de riesgo entre el sistema público y privado de salud en Chile. Georgetown University; 2005. | Link |
  30. Cid C. Diagnoses-based risk adjusted capitation payments for improving solidarity and efficiency in the Chilean health care system: evaluation and comparison with a demographic model. Department of Economics-Institute for Health Care Management, Universität Duisburg-Essen, Campus Essen; 2011. | Link |
  31. Gobierno de Chile, Ministerio de Salud. Informe final, estudio de verificación del costo esperado individual promedio por beneficiario del conjunto priorizado de problemas de salud con garantías explícitas - 2009. Santiago, Chile: MINSAL; 2009.
  32. Luengo-Fernandez R, Leal J, Sullivan R. Economic burden of malignant neoplasms in the European Union. Poster Presentation at Congress of the European Society for Medical Oncology Vienna, Austria, 2012.
  33. Sanchez M. Análisis estadístico del sistema sistema de Instituciones de Salud Previsional con enfoque de género. Departamento de Estudios y Desarrollo, Superintendencia de Salud, Marzo 2013.
  34. Ellis RP. Risk adjustment in health care markets: concepts and applications, in financing health care: new ideas for a changing society. Weinheim, Germany: Wiley-VCH Verlag GmbH & Co; 2008.
  35. Woolhandler S, Himmelstein DU. Consumer directed healthcare: except for the healthy and wealthy it's unwise. J Gen Intern Med. 2007 Jun;22(6):879-81. | PubMed |
Szot Meza J. La transición demográfico-epidemiológica en Chile, 1960-2001. Rev Esp Salud Pública 2003 Sep-Oct;77(5):605-13. | Link |

OMS. Cáncer. Nota descriptiva N°297. Febrero de 2015 who.int [on line]. | Link |

Gobierno de Chile, Ministerio de Salud. Home page, Departamento de Estadísticas e Información en Salud (DEIS). deis.minsal.cl [on line] | Link |

Gobierno de Chile, Ministerio de Salud. Objetivos Sanitarios de la década 2000-2010. Evaluación final del período. Grado de cumplimiento de objetivos de impacto. Santiago, Chile: MINSAL; 2010.

Warren JL, Yabroff KR, Meekins A, Topor M, Lamont EB, Brown ML. Evaluation of trends in the cost of initial cancer treatment. J Natl Cancer Inst. 2008 Jun 18;100(12):888-97. | CrossRef | PubMed |

Gobierno de Chile, Ministerio de Salud. Estudio de Carga de Enfermedad y Carga Atribuible. Santiango, Chile: MINSAL; 2007. | Link |

Gobierno de Chile, Ministerio de Salud. lnforme Final. Estudio Costo-efectividad de Intervenciones en Salud. Santiago, Chile: MINSAL; Mayo 2010.
 | Link |

Jiménez J. Mapa de la Investigación en Cáncer en Chile (Cancer Research Map Chile). Consorcio Tecnológico en Biomedicina Clínico-Molecular Aplicada (BMRC-Chile), Diciembre 2010.

Drummond M. Cost-of-illness studies: a major headache? Pharmacoeconomics. 1992 Jul;2(1):1-4. | PubMed |

World Health Organization. WHO guide to identifying the economic consequences of disease and injury. Department of Health Systems Financing, Health Systems and Services. Geneva, Switzerland: WHO;2009. | Link |

Health at a Glance 2015. OECD Publications. oecd.org [on line]. | Link |

World Health Organization. Global Health Observatory Data Repository. who.int [on line]. | Link |

Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet. 2007 Dec 8;370(9603):1929-38. | PubMed |

Liu JL, Maniadakis N, Gray A, Rayner M. The economic burden of coronary heart disease in the UK. Heart. 2002 Dec;88(6):597-603. | PubMed |

Cohen JW, Krauss NA. Spending and service use among people with the fifteen most costly medical conditions, 1997. Health Aff; 2003:129-138.

Druss BG, Marcus SC, Olfson M, Tanielian T, Elinson L, Pincus HA. Comparing the national economic burden of five chronic conditions. Health Aff (Millwood). 2001 Nov-Dec;20(6):233-41. | PubMed |

Druss BG, Marcus SC, Olfson M, Pincus HA. The most expensive medical conditions in America. Health Aff (Millwood). 2002 Jul-Aug;21(4):105-11. | PubMed |

American Heart Association. Heart disease and stroke statistics -2001 update. Dallas: American Heart Association; 2001.

Russell MW, Huse DM, Drowns S, Hamel EC, Hartz SC. Direct medical costs of coronary artery disease in the United States. Am J Cardiol. 1998 May 1;81(9):1110-5. | PubMed |

Currie CJ, Morgan CL, Peters JR. Patterns and costs of hospital care for coronary heart disease related and not related to diabetes. Heart. 1997 Dec;78(6):544-9. | PubMed |

Heijink R, Noethen M, Renaud T, Koopmanschap M, Polder J. Cost of illness: an international comparison. Australia, Canada, France, Germany and The Netherlands. Health Policy. 2008 Oct;88(1):49-61. | CrossRef | PubMed |

Haga K, Matsumoto K, Kitazawa T, Seto K, Fujita S, Hasegawa T. Cost of illness of the stomach cancer in Japan - a time trend and future projections. BMC Health Serv Res. 2013 Jul 23;13:283. | CrossRef | PubMed |

Kriza C, Emmert M, Wahlster P, Niederländer C, Kolominsky-Rabas P. Cost of illness in colorectal cancer: an international review. Pharmacoeconomics. 2013 Jul;31(7):577-88. | CrossRef | PubMed |

Sorensen SV, Goh JW, Pan F, Chen C, Yardley D, Martín M, et al. Incidence-based cost-of-illness model for metastatic breast cancer in the United States. Int J Technol Assess Health Care. 2012 Jan;28(1):12-21. | CrossRef | PubMed |

Guy GP, Ekwueme DU. Years of potential life lost and indirect costs of melanoma and non-melanoma skin cancer: a systematic review of the literature. Pharmacoeconomics. 2011 Oct;29(10):863-74. | CrossRef | PubMed |

Cooper BS, Rice DP. The economic cost of illness revisited. Social Security Bulletin. 1976;39:21-36. | Link |

Rice DP, Hodgson TA, Kopstein AN. The economic costs of illness: a replication and update. Health Care Financ Rev. 1985 Fall;7(1):61-80. | PubMed |

Bitrán R, Muñoz J, Navarrete M, Aguad P, Ubilla G. Equidad en el Financiamiento del Seguro Público de Salud: Informe Final. Santiago, Chile: MINSAL; 1996.

Vargas V, Cid C, Matus M, Delgado I, Sánchez JM, Heyermann B, Angulo J. Una metodología para ajustar y compensar las diferencias de riesgo entre el sistema público y privado de salud en Chile. Georgetown University; 2005. | Link |

Cid C. Diagnoses-based risk adjusted capitation payments for improving solidarity and efficiency in the Chilean health care system: evaluation and comparison with a demographic model. Department of Economics-Institute for Health Care Management, Universität Duisburg-Essen, Campus Essen; 2011. | Link |

Gobierno de Chile, Ministerio de Salud. Informe final, estudio de verificación del costo esperado individual promedio por beneficiario del conjunto priorizado de problemas de salud con garantías explícitas - 2009. Santiago, Chile: MINSAL; 2009.

Luengo-Fernandez R, Leal J, Sullivan R. Economic burden of malignant neoplasms in the European Union. Poster Presentation at Congress of the European Society for Medical Oncology Vienna, Austria, 2012.

Sanchez M. Análisis estadístico del sistema sistema de Instituciones de Salud Previsional con enfoque de género. Departamento de Estudios y Desarrollo, Superintendencia de Salud, Marzo 2013.

Ellis RP. Risk adjustment in health care markets: concepts and applications, in financing health care: new ideas for a changing society. Weinheim, Germany: Wiley-VCH Verlag GmbH & Co; 2008.

Woolhandler S, Himmelstein DU. Consumer directed healthcare: except for the healthy and wealthy it's unwise. J Gen Intern Med. 2007 Jun;22(6):879-81. | PubMed |