[Lung cancer diagnosis: hospitalization costs]

To establish the direct costs of the process of diagnosing lung cancer in 2003. As a secondary objective, the cost of admissions defined as inappropriate was evaluated.

A prospective cohort study of lung cancer cases diagnosed in 2003 was performed. Diagnosis was based on cytohistology or clinical and radiological criteria. The total cost was determined according to Decree 222/2003, governing Galician health service rates. A distinction was drawn between hospitalized patients and outpatients, and between small cell and non-small cell carcinomas. Inappropriate admissions were analyzed in accordance with the criteria established by our study team, and the savings that would have been made had these patients been treated as outpatients were calculated. The statistical analyses were performed using SPSS version 10.0.

A total of 160 patients were diagnosed with lung cancer; 76 (47.5%) of these were outpatients, and the remaining 84 (52.5%) were hospitalized patients. Admissions were considered inappropriate in 27 cases. Of the total of 160 patients, 108 were diagnosed as having non-small cell carcinomas, and 38 as having small cell carcinomas; the remaining 14 patients were diagnosed on the basis of clinical-radiological criteria. Total cost was 742,847 Euro(mean, 4643 Euro; 95% confidence interval, 4049-5236 Euro), composed of 552,614 Euro(mean, 6579 Euro) for admitted patients, and 190,233 Euro(mean, 2503 Euro) for outpatients. Mean cost was 3692 Euro for the small cell carcinomas, and 5070 Euro for the non-small cell carcinomas. Comparing limited and extensive small cell carcinomas, the mean cost for the former was significantly lower than for the latter (1894 Euro compared to 4098 Euro); there was also a lower mean cost for early compared to advanced stages of non-small cell carcinomas (3660 Euro compared to 5494 Euro). The savings to be made from unnecessary admissions were calculated at 120,258 Euro.

The mean cost for outpatient lung cancer treatment was 62% lower than for hospitalization. Non-small cell carcinomas were more costly on average than small cell carcinomas, and advanced stages of the small cell carcinomas involved a higher average cost than the initial stages of the disease. For our series, the savings to be made from unnecessary admissions were calculated at 120,258 Euro.