Kolon ve Rektum Kanseri Tedavisinde Yukarıdan Aşağı ve Aşağıdan Yukarı Maliyet Yaklaşımlarının Karşılaştırılması

Abstract

Colon and rectum are part of the digestive system and the cancer that occurs in any of these organs is often called colorectal cancer (CRC). Colorectal cancer (CRC) is the third most commonly occuring cancer worldwide with over 1 million people diagnosed annualy and with aging population it is expected that CRC cases will increase. In Turkey, the incidence of CRC in 2010 is 20,7/100.000 for men and 13,1/100.000 for women. With these rates based on sex, CRC was ranked as the fourth most common type of cancer in men and the third most common type of cancer in women in Turkey. In recent years, there have been significant increases in health expenditures all around the world and also in Turkey. This increase in health expenditures is due to many factors such as the cost of medical diagnosis and treatment, as well as the loss of work force and quality of life caused by illnesses. Due to the limited resources allocated for healthcare services, it is important to study the costs of diseases such as CRC, which cause a high burden of disease for countries. The aim of the study is to determine the cost of colon and rectal cancer with top down and bottom up cost approaches with the third-party payer (SSI) perspective and compare the methodogies used in the study. A total of 62.970 patients admitted to hospitals which have an agreement with Social Security Institution (SSI) in Turkey, from January 1, 2014, until the December 31, 2014, was examined for the cost analysis from top down cost approach and patient’s data were taken from MEDULA (National Electronic Invoice System). At the same time, the data of 448 patients diagnosed with colon and rectal cancer from January 1, 2014, until the December 31, 2014 were obtained from a private university hospital for the cost analysis from top down cost approach. Expert opinions were used for the cost analysis from bottom up cost approach. The forms prepared for the determination of expert opinions of colon and rectal cancer treatment were filled by 5 medical oncologists and 6 general surgeons and calculations were made through these forms. Large differences arise between the top-down and the bottom-up cost approach for colon and rectal cancer treatment in this study. The cost of colon and rectal cancer treatments were higher according to the bottom-up cost approach.

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According to the data obtained from SSI MEDULA system, average cost per patient are 3.055,5TL for colon cancer, 4.126,2TL for rectal cancer and according to the data obtained from private university hospital, average cost per patient are 5.875,3TL for colon cancer, 4.885,6TL for rectal cancer with top-down cost approach, and with 14.920,4TL for colon cancer and 17.904,6TL for rectal cancer with bottom-up cost approach. In conclusion, we recommend to assess cost of illness in a combined design.