Ödeyici Kurum Bakış Açısıyla İleri Evre Böbrek Kanserinde Kaynak Kullanımı: Eğitim ve Araştırma Hastanesi Örneği

Yıl 2022, Cilt: 13 Sayı: 34, 520 - 534, 20.05.2022

Hüseyin Demir , Pınar Yalçın Balçık

https://doi.org/10.21076/vizyoner.991598

Cited By: 1

Öz

Çalışmanın amacı, ileri evre böbrek kanseri hastalığını sağlık ekonomisi bağlamında değerlendirmek, hastalığa ilişkin kaynak kullanımını ödeyici kurum bakış açısıyla araştırmaktır. Çalışma tanımlayıcı tipte kesitsel bir araştırma olup araştırmanın evreni 2611 hastadan oluşmaktadır. Veri; hizmet, ilaç ve malzeme olmak üzere üç kategoride değerlendirilmiştir. Analizler bütün hastalara ilişkin veriler kullanılarak yürütülmüştür. Veri analizinde R programı kullanılmıştır. Bulgulara göre, hastaların %52,7’si (1376 hasta) nefrektomi operasyonu geçirmiştir. İEBK hastalığında hizmet, ilaç ve malzemeler yoğun bir biçimde kullanılmaktadır. Hizmet ve malzemeler oldukça yoğun kullanılmalarına karşın bu kaynaklara ilişkin maliyetlerin bir kısmının, ilaç kullanımına ilişkin maliyetlerin ise neredeyse tamamının ödeyici kurum tarafından karşılandığı anlaşılmıştır. Dolayısıyla ilaç kullanımı ödeyici kurum üzerinde zorlayıcı bir etkiye sahiptir. Diğer yandan, hizmet sunumunda kullanılan kaynaklar için ödenen tutarların sürekli olarak artış gösterdiği saptanmıştır. Bu trend, ödeyici kurum bütçesi üzerindeki yükün fazla olduğunu ve bu yükün git gide artabileceğini göstermektedir. Sonuç olarak, hastalığın tedavisi ilaç-yoğun karaktere sahiptir. Bu bulgu, özellikle kemoterapi ilaçları ile sağlanan sağlık sonuçlarının ölçülmesi gerektiğine ilişkin ihtiyacı ortaya koymaktadır.

Anahtar Kelimeler

İleri Evre Böbrek Kanseri, Ödeyici Kurum, Kaynak Kullanımı

Resource Use in Advanced Renal Cancer with the Payer Institution Perspective: The Case of Training and Research Hospital

Öz

The study aims to evaluate advanced renal cancer disease in the context of health economics and to investigate the resource-use related to the disease with the payer institution perspective. The study is descriptive and cross-sectional, and population consists of 2,611 patients. The data falls into the categories of service, medicine and material. Analyzes are done using the data of all patients. R program is utilized to discover and visualize the data. According to the findings, 52.7% of the patients (1,376 patients) underwent nephrectomy operation. Services, drugs, and materials are used extensively in the disease. Although services and materials are used extensively, the costs of these resources are partially reimbursed, whereas almost all costs related to drugs are reimbursed. Therefore, the drugs have a challenging burden on the institution. On the other hand, the amount paid for the resources used in providing services has gradually increased. This trend suggests that the burden on the institution’s budget is high and it may gradually increase. The study points to the finding that the treatment of the disease has a drug-intensive character. This finding, in return, makes it necessary to measure the health outcomes brought about by chemotherapy drugs.

Anahtar Kelimeler

Advanced Renal Cancer, Payer Institution, Resource Use

Kaynakça

• Capitanio, U., Bensalah, K., Bex, A., Boorjian, S. A., Bray, F., Coleman, J., Gore, J. L., Sun, M., Wood, C. ve Russo, P. (2019). Epidemiology of renal cell carcinoma. European Urology, 75(1), 74-84.
• Chien, C. R., Geynisman, D. M., Kim, B., Xu, Y. ve Shih, Y. C. T. (2019). Economic burden of renal cell carcinoma – part ı: An updated review. Pharmacoeconomics, 37(3), 301-331.
• Delea, T. E., Amdahl, J., Diaz, J., Nakhaipour, H. R. ve Hackshaw, M. D. (2015). Cost-effectiveness of pazopanib versus sunitinib for renal cancer in the United States. Journal of Managed Care & Specialty Pharmacy, 21(1), 46-54.
• Escudier, B., Eisen, T., Stadler, W. M., Szczylik, C., Oudard, S., Siebels, M., Negrier, S., Chevreau, C., Solska, E., Desai, A. A., Rolland, F., Demkow, T., Hutson, T. E., Gore, M., Freeman, S., Schwartz, B., Shan, M., Simantov, R. ve Bukowski, R. M. (2007). Sorafenib in advanced clear-cell renal-cell carcinoma. New England Journal of Medicine, 356(2), 125-134.
• Escudier, B., Porta, C., Schmidinger, M., Rioux-Leclercq, N., Bex, A., Khoo, V., Grünwald, V., Gillessen, S. ve Horwich, A. (2019). Renal cell carcinoma: Esmo clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 30(5), 706-720.
• Frampton, J. E. (2017). Pazopanib: A review in advanced renal cell carcinoma. Targeted Oncology, 12(4), 543-554.
• Gore, M. E., Szczylik, C., Porta, C., Bracarda, S., Bjarnason, G. A., Oudard, S., Hariharan, S., Lee, S. H., Haanen, J., Castellano, D., Vrdoljak, E., Schöffski, P., Mainwaring, P., Nieto, A., Yuan, J. ve Bukowski, R. (2009). Safety and efficacy of sunitinib for metastatic renal-cell carcinoma: An expanded-access trial. The Lancet Oncology, 10(8), 757-763.
• Guo, J., Jin, J., Oya, M., Uemura, H., Takahashi, S., Tatsugami, K., Rha, S. Y., Lee, J. Y., Chung, J., Lim, H. Y., Wu, H. C., Chang, Y. H., Azad, A., Davis, I. D., Carrasco-Alfonso , M. J., Nanua , B., Han, J., Ahmad, Q. ve Motzer, R. (2018). Safety of pazopanib and sunitinib in treatment-naive patients with metastatic renal cell carcinoma: Asian versus non-asian subgroup analysis of the comparz trial. Journal of Hematology and Oncology, 11(1), 1-10.
• Hall, J. P., Zanotti, G., Kim, R., Krulewicz, S. P., Leith, A., Bailey, A., Liu, F. X. ve Kearney, M. (2020). Treatment patterns, outcomes and clinical characteristics in advanced renal cell carcinoma: A real-world US study. Future Oncology, 16(36), 3045-3060.
• Hofmarcher, T., Lindgren, P., Wilking, N. ve Jo¨nsson, B. (2020). The cost of cancer in Europe 2018. European Journal of Cancer, 129, 41-49.
• Kadom, N., Itri, J. N., Trofimova, A., Otero, H. J. ve Horný, M. (2019). Cost-effectiveness analysis: An overview of key concepts, recommendations, controversies, and pitfalls. Academic Radiology, 26(4), 534-541.
• Kim, M. S., Chung, H. S., Hwang, E. C., Jung, S. I., Kwon, D. D., Hwang, J. E., Bae, W. K., Park, J. Y., Jeong, C. W., Kwak, C., Song, C., Seo, S. I., Byun, S. S., Hong, S. H. ve Chung, J. (2018). Efficacy of first-line targeted therapy in real-world korean patients with metastatic renal cell carcinoma: Focus on sunitinib and pazopanib. J Korean Med Sci, 17(33), 1-10.
• Masini, C., Vitale, M. G., Maruzzo, M., Procopio, G., de Giorgi, U., Buti, S., Rossetti, S., Iacovelli, R., Atzori, F., Cosmai, L., Vignani, F., Prati, G., Scagliarini, S., Guida, A., Berselli, A. ve Pinto, C. (2019). Safety and efficacy of pazopanib in first-line metastatic renal-cell carcinoma with or without renal failure: Core-uro-01 study. Clinical Genitourinary Cancer, 17(1), 150-155.
• Meacock, R. (2019). Methods for the economic evaluation of changes to the organisation and delivery of health services: Principal challenges and recommendations. Health Economics, Policy and Law, 14(1), 119-134.
• Meyer, A. R., Allaf, M. E. ve Gorin, M. A. (2019). Epidemiology and risk factors of renal cell carcinoma. M. A. Gorin, ve M. E. Allaf, (Ed.), Diagnosis and surgical management of renal tumors içinde (s. 1-12). Springer International Publishing.
• Motzer, R. J., Hutson, T. E., Cella, D., Reeves, J., Hawkins, R., Guo, J., Nathan, P., Staehler, M., de Souza, P., Merchan, J. R., Boleti, E., Fife, K., Jin, J., Jones, R., Uemura, H., Giorgi, U. D., Harmenberg, U., Wang, J., Sternber, C. N., Deen, K., McCann, L., Hackshaw, M. D., Crescenzo, R., Pandite, L. N. ve Choueiri, T. K. (2013). Pazopanib versus sunitinib in metastatic renal-cell carcinoma. New England Journal Of Medicine, 369(8), 722-731.
• Motzer, R. J., Penkov, K., Haanen, J., Rini, B., Albiges, L., Campbell, M. T., Venugopal, B., Kollmannsberger, C., Negrier, S., Uemura, M., Lee, J. L., Vasiliev, A., Miller, W. H., Gurney, H., Schmidinger, M., Larkin, J., Atkins, M. B., Bedke, J., Alekseev, B., Wang, J., Mariani, M., Robbins, P. B., Chudnovsky, A., Fowst, C., Hariharan, S., Huang, B., di Pietro, A. ve Choueiri, T. K. (2019). Avelumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. New England Journal of Medicine, 380(12), 1103-1115.
• Moynihan, R. ve Cassels, A. (2020). Satılık hastalıklar. (G. Tamer ve E. Yıldırım, Çev.), Hayygrup Yayıncılık.
• OECD. (2022). Pharmaceutical spending (indicator). https://doi.org/10.1787/998febf6-en adresinden 6 Ocak 2022 tarihinde alınmıştır.
• Padala, S. A., Barsouk, A., Thandra, K. C., Saginala, K., Mohammed, A., Vakiti, A., Rawla, P. ve Barsouk, A. (2020). Epidemiology of renal cell carcinoma. World Journal of Oncology, 11(3), 79-87.
• Park, J. ve Look, K. A. (2019). Health care expenditure burden of cancer care in the United States. The Journal of Health Care Organization, Provision, and Financing, 56, 1-9.
• Perego, G., Barzaghi, P., Vavassori, I. ve Petrelli, F. (2020). Treating metastatic clear-cell renal cell carcinoma: Beyond immunotherapy. Medical Oncology, 37(9), 1-5.
• Procopio, G., Bamias, A., Schmidinger, M., Hawkins, R., Sánchez, A. R., Estevez, S. V., Srihari, N., Kalofonos, H., Bono, P., Pisal, C. B., Hirschberg, Y., Dezzani, L., Ahmad, Q., Rodriguez, C. S. ve Jonasch, E. (2019). Real-world effectiveness and safety of pazopanib in patients with intermediate prognostic risk advanced renal cell carcinoma. Clinical Genitourinary Cancer, 17(3), 526-533.
• Purmonen, T., Martikainen, J. A., Soini, E. J. O., Kataja, V., Vuorinen, R. L. ve Kellokumpu-Lehtinen, P. L. (2008). Economic evaluation of sunitinib malate in second-line treatment of metastatic renal cell carcinoma in Finland. Clinical Therapeutics, 30(2), 382-392.
• Purmonen, T., Nuttunen, P., Vuorinen, R., Pyrhönen, S., Kataja, V. ve Kellokumpu-Lehtinen, P. (2010). Current and predicted cost of metastatic renal cell carcinoma in Finland. Acta Oncologica, 49(6), 837-843.
• Rowe, S. P., Yin, Y. ve Gorin, M. A. (2019). Imaging of renal tumors. M. A. Gorin ve M. E. Allaf (Ed.), Diagnosis and surgical management of renal tumors içinde (s. 55-70), Springer International Publishing.
• Schmidinger, M., Bamias, A., Procopio, G., Hawkins, R., Sanchez, A. R., Vázquez, S., Srihari, N., Kalofonos, H., Bono, P., Pisal, C. B., Hirschberg, Y., Dezzani, L., Ahmad, Q. ve Jonasch, E. (2019). Prospective observational study of pazopanib in patients with advanced renal cell carcinoma (principal study). The Oncologist, 24(4), 491-497.
• Sheng, X., Jin, J., He, Z., Huang, Y., Zhou, A., Wang, J., Ren, X., Ye, D., Zhang, X., Qin, S., Zhou, F., Wang, B. ve Guo, J. (2020). Pazopanib versus sunitinib in chinese patients with locally advanced or metastatic renal cell carcinoma: Pooled subgroup analysis from the randomized, comparz studies. BMC Cancer, 20(1), 1-8.
• Shih, Y. C., Chien, C. R., Xu, Y., Pan, I. W., Smith, G. L. ve Buchholz, T. A (2011). Economic burden of renal cell carcinoma: Part I--an updated review. Pharmacoeconomics, 29(4), 315-29.
• Shiroiwa, T., Fukuda, T., Ikeda, S., Takura, T. ve Moriwaki, K. (2017). Development of an official guideline for the economic evaluation of drugs/medical devices in Japan. Value in Health, 20(3), 372-378.
• Simard, H., Sabbagh, R., Ouellet, S., Richard, P. ve Jeldres, C. (2018). The impact of targeted therapy on healthcare resource use in patients with metastatic renal cell carcinoma: The university of sherbrooke experience. Canadian Urological Association Journal, 12(9), 373-377.
• Stanfield, P. ve Cross, N. (2018). Temel tıbbi terminoloji. (İ. İlhanlı, Çev.), Nobel Akademik Yayıncılık.
• Vargas, C., Balmaceda, C., Rodríguez, F., Rojas, R., Giglio, A. ve Espinoza, M. A. (2019). Economic evaluation of sunitinib versus pazopanib and best supportive care for the treatment of metastatic renal cell carcinoma in Chile: Cost-effectiveness analysis and a mixed treatment comparison. Expert Review of Pharmacoeconomics and Outcomes Research, 19(5), 609-617.
• Vuorinen, R. L., Paunu, N., Turpeenniemi-Hujanen, T., Reunamo, T., Jekunen, A., Kataja, V., Sintonen, H., Purmonen, T. ve Kellokumpu-Lehtinen, P. L. (2019). Sunitinib first-line treatment in metastatic renal cell carcinoma: Costs and effects. Anticancer Research, 39(10), 5559-5564.