title: Estimation of lung cancer diagnosis and treatment costs based on a patient-level analysis in Catalonia (Spain).
abstract: BACKGROUND
  Assessing of the costs of treating disease is necessary to demonstrate cost-effectiveness and to estimate the budget impact of new interventions and therapeutic innovations. However, there are few comprehensive studies on resource use and costs associated with lung cancer patients in clinical practice in Spain or internationally. The aim of this paper was to assess the hospital cost associated with lung cancer diagnosis and treatment by histology, type of cost and stage at diagnosis in the Spanish National Health Service.
  
  
  METHODS
  A retrospective, descriptive analysis on resource use and a direct medical cost analysis were performed. Resource utilisation data were collected by means of patient files from nine teaching hospitals. From a hospital budget impact perspective, the aggregate and mean costs per patient were calculated over the first three years following diagnosis or up to death. Both aggregate and mean costs per patient were analysed by histology, stage at diagnosis and cost type.
  
  
  RESULTS
  A total of 232 cases of lung cancer were analysed, of which 74.1% corresponded to non-small cell lung cancer (NSCLC) and 11.2% to small cell lung cancer (SCLC); 14.7% had no cytohistologic confirmation. The mean cost per patient in NSCLC ranged from 13,218 Euros in Stage III to 16,120 Euros in Stage II. The main cost components were chemotherapy (29.5%) and surgery (22.8%). Advanced disease stages were associated with a decrease in the relative weight of surgical and inpatient care costs but an increase in chemotherapy costs. In SCLC patients, the mean cost per patient was 15,418 Euros for limited disease and 12,482 Euros for extensive disease. The main cost components were chemotherapy (36.1%) and other inpatient costs (28.7%). In both groups, the Kruskall-Wallis test did not show statistically significant differences in mean cost per patient between stages.
  
  
  CONCLUSIONS
  This study provides the costs of lung cancer treatment based on patient file reviews, with chemotherapy and surgery accounting for the major components of costs. This cost analysis is a baseline study that will provide a useful source of information for future studies on cost-effectiveness and on the budget impact of different therapeutic innovations in Spain.
authors.affiliation: Department of Pediatrics, Obstetrics, Gynecology and Preventive Medicine, Autonomous University of Barcelona, Barcelona, Spain. jcorral@iconcologia.net.|Catalan Cancer Strategy, Department of Health, Generalitat de Catalunya, Barcelona, Spain. jcorral@iconcologia.net.|Cancer Prevention and Control [Bellvitge Biomedical Research Institute] - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain. jcorral@iconcologia.net.
authors.forename: Julieta
authors.initials: J
authors.lastname: Corral
authors.affiliation: Catalan Cancer Strategy, Department of Health, Generalitat de Catalunya, Barcelona, Spain. ja.espinas@iconcologia.net.|Cancer Prevention and Control [Bellvitge Biomedical Research Institute] - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain. ja.espinas@iconcologia.net.
authors.forename: Josep Alfons
authors.initials: JA
authors.lastname: Espinàs
authors.affiliation: Parc de Salut Mar, Barcelona, Spain. FCots@parcdesalutmar.cat.
authors.forename: Francesc
authors.initials: F
authors.lastname: Cots
authors.affiliation: Catalan Cancer Strategy, Department of Health, Generalitat de Catalunya, Barcelona, Spain. l.pareja@iconcologia.net.|Cancer Prevention and Control [Bellvitge Biomedical Research Institute] - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain. l.pareja@iconcologia.net.
authors.forename: Laura
authors.initials: L
authors.lastname: Pareja
authors.affiliation: Catalan Cancer Strategy, Department of Health, Generalitat de Catalunya, Barcelona, Spain. jsola@iconcologia.net.|Cancer Prevention and Control [Bellvitge Biomedical Research Institute] - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain. jsola@iconcologia.net.
authors.forename: Judit
authors.initials: J
authors.lastname: Solà
authors.affiliation: Catalan Cancer Strategy, Department of Health, Generalitat de Catalunya, Barcelona, Spain. rfont@iconcologia.net.|Cancer Prevention and Control [Bellvitge Biomedical Research Institute] - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain. rfont@iconcologia.net.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Font
authors.affiliation: Catalan Cancer Strategy, Department of Health, Generalitat de Catalunya, Barcelona, Spain. jmborras@iconcologia.net.|Cancer Prevention and Control [Bellvitge Biomedical Research Institute] - IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain. jmborras@iconcologia.net.|Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. jmborras@iconcologia.net.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Borràs
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain