doiSerbia

End-of-life costs of medical care for advanced stage cancer patients

Kovačević Aleksandra (Military Medical Academy, Centre for Clinical Pharmacology, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade)
Dragojević-Simić Viktorija (Military Medical Academy, Centre for Clinical Pharmacology, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade)
Rančić Nemanja (Military Medical Academy, Centre for Clinical Pharmacology, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade)
Jurišević Milena (Faculty of Medical Sciences, Department of Pharmacy, Kragujevac)
Gutzwiller Florian S. (University of Basel, Institute of Pharmaceutical Medicine/ECPM, Basel, Switzerland)
Matter-Walstra Klazien (University of Basel, Institute of Pharmaceutical Medicine/ECPM, Basel, Switzerland)
Jakovljević Mihajlo (Faculty of Medical Sciences, Department of Pharmacology and Toxicology, Kragujevac)

Background/Aim. Cancer, one of the leading causes of mortality in the world, imposes a substantial economic burden on each society, including Serbia. The aim of this study was to evaluate the major cancer cost drivers in Serbia. Methods. A retrospective, indepth, bottom-up analysis of two combined databases was performed in order to quantify relevant costs. End-of-life data were obtained from patients with cancer, who deceased within the first year of the established diagnose, including basic demographics, diagnosis, tumour histology, medical resource use and related costs, time and cause of death. All costs were allocated to one of the three categories of cancer health care services: primary care (included home care), hospital outpatient and hospital inpatient care. Results. Exactly 114 patients were analyzed, out of whom a high percent (48.25%) had distant metastases at the moment of establishing the diagnosis. Malignant neoplasms of respiratory and intrathoracic organs were leading causes of morbidity. The average costs per patient were significantly different according to the diagnosis, with the highest (13,114.10 EUR) and the lowest (4.00 EUR) ones observed in the breast cancer and melanoma, respectively. The greatest impact on total costs was observed concerning pharmaceuticals, with 42% of share (monoclonal antibodies amounted to 34% of all medicines and 14% of total costs), followed by oncology medical care (21%), radiation therapy and interventional radiology (11%), surgery (9%), imaging diagnostics (9%) and laboratory costs (8%). Conclusion. Cancer treatment incurs high costs, especially for end-of-life pharmaceutical expenses, ensued from medical personnel tendency to improve such patients’ quality of life in spite of nearing the end of life. Reimbursement policy on monoclonal antibodies, in particular at end-stage disease, should rely on cost-effectiveness evidence as well as documented clinical efficiency.

Keywords: health care costs, Serbia, carcinoma, drug therapy, antibodies, monoclonal, terminal care

Projekat Ministarstva nauke Republike Srbije, br. 175014