Reconciling Cancer Care Costs Reported by Different Government Agencies in Taiwan: Why Costing Approach Matters?

Few studies have explored how differences in costing methods may contribute to a discrepancy in the cost of cancer reported by different government agencies.

By using claims data of cancer patients and controls identified from 2005 to 2007 claims data in Taiwan, we sought to understand the discrepancy in public reporting of cancer care costs by comparing four costing methods on the basis of the definition of cancer and cancer-related services employed by three agencies: Department of Health, Bureau of National Health Insurance (BNHI), and National Health Research Institute (NHRI). We also compared two costing approaches, the attributable cost approach versus the net cost approach, in terms of total cost, number of cancer cases, and average cost per patient.

The estimated total cost of cancer was highest (1.65 billion relative value units [RVUs] in 2005) from the NHRI method and lowest from the Department of Health method (1.20 billion RVUs). The Department of Health and NHRI methods tended to report higher number of cancer cases than did the BNHI and net cost methods. The estimated cost per patient was lowest from the NHRI costing method (34,139 RVUs) and highest from the BNHI method (94,115 RVUs). Projection to national cost showed that the percentages of national health expenditure for cancer ranged from 3.9% to 5.3% in 2005.

The estimated costs of cancer care can vary widely (more than 10 billion New Taiwan dollars) by costing methods. The BNHI costing method appeared to produce estimates similar to those produced by the net cost approach.