Analysis of treatment cost for neuroblastoma to the family: a single-center cross-sectional study in China

Neuroblastoma (NB) is notorious in childhood cancer because of its high incidence and poor prognosis. The Children’s Oncology Group reported that the 3-year OS in the high-risk (HR) group is 50%, and the HR-NB with bone marrow metastasis in our center is 43.1%. Thousands of families in China suffer from the cost of NB, but the true costs of therapy are unknown; to date, no study has ever performed a detailed therapy costs analysis for NB. The objective of this study was to assess the economic burden of NB treatment in children to the family, to ultimately reduce related expenses for patients and promote the establishment of NB management policy. Data in this cross-sectional study were collected via questionnaires completed by parents at the outpatient clinic and was verified via a computer system. Therapy costs of children with NB of differing risks were analyzed through descriptive statistics (1 CNY ≈ 0.1412 USD). Median direct medical costs of low risk (LR), middle risk (MR), and HR NB during treatment were 180.0 (120.0, 300.0), 200.0 (166.0, 300.0), and 650.0 (415.5, 850.0) thousand Chinese yuan (CNY), respectively. Direct non-medical costs including transportation, food, and accommodation were 60.0 (37.0, 100.0), 80.0 (60.0, 120.0), and 100.0 (80.0, 157.5) thousand CNY in the LR, MR, and HR groups, respectively. Additionally, parents accrued work absences to attend treatment, and lost a total of 100.0 (50.0, 150.0) thousand CNY in indirect costs. Families whose children had relapsed or died were excluded from this analysis and therefore limited the conclusions drawn. Parents were asked to recall costs since initial diagnosis (1–6 years in the past), but this extended time period may have introduced recall bias. Direct non-medical and indirect costs play an important role in the total treatment costs of NB. Children with NB treated in local hospitals and followed up in hospital specialized in childhood oncology may save many unnecessary expenses. China's healthcare system should establish mechanisms and provide financial support for children with NB.

神经母细胞瘤（Neuroblastoma, NB）是儿童恶性肿瘤中危害极为突出的病种，兼具高发病率与不良预后两大特征。儿童肿瘤协作组（Children’s Oncology Group）曾报道，高危（high-risk, HR）组患儿的3年总生存期（Overall Survival, OS）仅为50%；本中心伴骨髓转移的高危神经母细胞瘤（HR-NB）患者的3年OS则为43.1%。国内数以千计的家庭承受着神经母细胞瘤治疗的经济压力，但目前尚未明确该病的真实治疗成本，迄今尚无针对神经母细胞瘤治疗成本的详细分析研究。本项横断面研究旨在评估儿童神经母细胞瘤治疗给家庭带来的经济负担，以期最终降低患者的相关治疗支出，推动神经母细胞瘤诊疗政策的制定与完善。本研究通过门诊患儿家长填写的问卷收集数据，并依托计算机系统完成核查验证。采用描述性统计方法分析不同风险分层神经母细胞瘤患儿的治疗成本（1元人民币≈0.1412美元）。低危（low-risk, LR）、中危（middle-risk, MR）及高危组患儿治疗期间的直接医疗成本中位数分别为18.0（12.0, 30.0）、20.0（16.6, 30.0）及65.0（41.55, 85.0）万元人民币。低、中、高危组的直接非医疗成本（涵盖交通、伙食与住宿费用）中位数分别为6.0（3.7, 10.0）、8.0（6.0, 12.0）及10.0（8.0, 15.75）万元人民币。此外，患儿家长因陪同治疗缺勤产生的间接成本中位数为10.0（5.0, 15.0）万元人民币。本研究排除了患儿复发或死亡的家庭进行相关分析，因此结论存在一定局限性。研究要求家长回忆自初始诊断以来（过去1~6年）的各项花费，较长的时间跨度可能引入回忆偏倚。直接非医疗成本与间接成本在神经母细胞瘤总治疗成本中占据重要比例。在当地医院接受治疗并于儿童肿瘤专科医院随访的神经母细胞瘤患儿，可节省大量不必要的开支。我国医疗保障体系应建立针对儿童神经母细胞瘤患儿的保障机制并提供相应财政支持。