RESUMO
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 during1 March 2001 to 30 April 2001 were sequentially selected. Hospital charts were reviewed. History before diagnosis, type of treatments, 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 patent 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 (men + 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 mild 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, 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 increases the cost of treatment. An increased RW should be specially considered for this group.
RESUMO
Both bone and the breast are major target tissues of estrogen actions. The biological actions of estrogen depend on the interaction between estrogen and estrogen receptors (ER) in the target tissues. Therefore, ER concentration in tissues such as breast cancer might be associated with the amount of bone mass. The present study was aimed to examine whether there is a relationship between ER concentration in breast cancer tissue (ER-BCA) and bone mineral density (BMD). Forty-seven pre-menopausal and 34 post-menopausal women with newly diagnosed breast cancer were studied. The ER-BCA ranged from 0 to 339 fmol/mg cytosol protein (mean +/- SD = 68.6 +/- 97.0). Pearson's correlation analyses showed that ER-BCA negatively correlated to BMD of the spine (r = -0.251, p = 0.024), forearm (r = -0.341, p = 0.002), hip (r = -0.373, p = 0.001) and total body (r = -0.317, p = 0.004) in all 81 women. In 47 pre-menopausal women, the ER-BCA negatively correlated to the hip (r = -0.455, p = 0.001) and total body (r = -0.395, p = 0.006) but not to the spine and forearm BMD. Whereas, in 34 post-menopausal women, the ER-BCA negatively correlated to forearm BMD (r = -0.399, p = 0.019). Stepwise multiple regression analyses showed that the ER-BCA independently correlated to hip BMD in all 81 women (r = -0.373, p < 0.01) and in pre-menopausal women (r = -0.486, p < 0.001) and independently correlated to forearm BMD in post-menopausal women (r = -0.399, p < 0.05). The results of this study suggest that the presence of high estrogen receptor concentration in breast cancer tissue might induce a deleterious effect on bone mass particularly in pre-menopausal women.