Breast, cervical, and lung cancer: A comparison of real healthcare costs and INA-CBGs rates in the era of national health insurance

Fitriana Yuliastuti; Tri Murti Andayani; Dwi Endarti; Susi Ari Kristina

doi:10.18549/PharmPract.2023.1.2768

Breast, cervical, and lung cancer: A comparison of real healthcare costs and INA-CBGs rates in the era of national health insurance

Pharm Pract (Granada). 2023 Jan-Mar;21(1):2768. doi: 10.18549/PharmPract.2023.1.2768. Epub 2022 Jan 4.

Authors

Fitriana Yuliastuti¹, Tri Murti Andayani², Dwi Endarti³, Susi Ari Kristina⁴

Affiliations

¹ Doctoral Program in Pharmaceutical Science, Faculty of Pharmacy, Universitas Gadjah Mada Yogyakarta, Indonesia. Department of Pharmacy, Faculty of Health Science, Universitas Muhammadiyah Magelang, Magelang, Indonesia. fitrianayuliastuti@ummgl.ac.id.
² Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia. trimurtia@ugm.ac.id.
³ Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia. endarti_apt@ugm.ac.id.
⁴ Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia. susiari_k@ugm.ac.id.

Abstract

Background: In Indonesia, the cost of cancer treatment has been determined by the Indonesian Case Base Groups (INA-CBGs) based on a code called the INA-CBG's rates. However, a fair claim should be based on the severity of the disease and the class of treatment in the hospital, not on the rates of code. In fact, the real cost of therapy for cancer is influenced by several factors including stage, comorbidity, and severity (INA-CBGs coding, type of hospital, hospital class, treatment grade, side effects, and length of stay), so in many cases, there are reported differences between the real costs and the INA-CBGs rates charged to patients.

Objective: This study aims to investigate the difference between real treatment costs and INA-CBG's rates for cases of lung cancer, cervical cancer, and breast cancer at a cancer center hospital in Indonesia.

Methods: This work uses an observational study, and the data were taken retrospectively from hospital financial data and patient medical records. The data were then analyzed using a one-sample t-test to determine the difference between real costs and INA-CBGs costs.

Results: The results showed that there was no significant difference between real costs and INA-CBG's cost on stage II lung cancer treatment in grade 2 with a sig. value of 0.683; code C-4-13-II in grade 3 with a sig. value of 0.151; and code C-4-13-III in grade 3 with a sig. value of 0.650; where the significance level (t alpha) is more than 0.05. Furthermore, the treatment costs for cervical cancer with codes C-4-13-I and C-4-13-II in grade 1 had sig. values of 0.155 and 0.720 respectively. Lastly, the treatment cost for breast cancer patients with codes C-4-12-II in grade 3 had a sig. value of 0.145 and code C-4-13-II in grade 3 showed a sig. value of 0.091.

Conclusion: Although statistical evaluation showed a significant difference for some cases and not significant for other cases, in real conditions, there is a difference between the INA-CBGs and the real costs that must be evaluated by the government and stakeholders to provide justice for cancer patients.

Keywords: INA-CBGs rates; breast cancer; cervical cancer; lung cancer; real cost.