Breast Cancer : A Cost Analysis Study

Objective : To compare the unit cost and the reimbursement calculated by Thai Diagnosis Related Group (DRG) version 3 of breast cancer treatments. Methods : Thirty nine breast cancer patients who were underwent surgery during 1 March 2001 to 30 April 2001 were sequentially selected. Hospital charts were reviewed. History before diagnosis, type of tratments, laboratory details, hormonal therapy and other costs were recorded. Labor cost, material cost and capital cost were calculated as direct cost which also included the cost of doctor visits. Indirect costs included the cost of the facility. Unit cost of each patient was calculated and compared to the reimbursement calculated by Thai DRG version 3 (September 2002). Results : Of 39 breast cancer patients, total Relative Weight (RW) was 54.37 (mean ± SD = 1.39 ± 0.23) with full cost being 849,377.52 baht (mean ± SD = 21,778.91 ± 8,890.46). the total calculated reimbursement was 869,868.80 baht (mean ± SD = 22,304.33 ± 3,635.17). Calculation of reimbursement was based on the initial agreement that the university hospital would receive 16,000 baht in payment per 1 RW. Overall reimbursement was slightly higher than cost. Our study resulted in the classification of patients into 4 DRG groups as follows : 1) DRG 09010 (Total mastectomy for malignancy, no complication), 2) DRG 09012 (Total mastectomy for malignancy, with to moderate complication), 3) DRG 09014 (Total mastectomy for malignancy, with severe complication) and 4) DRG 09020 (Subtotal mastectomy for malignancy, no complication or Conservative breast surgery). Reimbursement was lower than cost in groups 2 and 4. In group 2, 1 out of 2 patients had a long hospital stay which resulted in a high average cost. Conversely, the unit cost of group 4 was not different from other groups but the RW given was lowest, which made the reimbursement much lower than real cost. Conclusion : In conservative breast surgery (group 4), patients must receive both surgical and radiation treatment to decrease the morbidity which increased the cost of treatment. An increased RW should be specially considered for this group