OBJECTIVES

The aim of the study is to estimate the cost of breast cancer diagnosis, treatment, and management in the Philippines. Specifically, it aims to identify the resource requirements and interventions related to breast cancer diagnosis, treatment, and management, measure resource volumes (number of units), learn to value resource items (unit costs), and determine the total cost of treatment per disease stage.

METHODS

The study covered nine tertiary hospitals, seven of which were government hospitals and two were private hospitals, with all tertiary hospitals providing breast cancer services and accredited by Philippine Health Insurance Corporation (PHIC or PhilHealth) for the Z-Benefit Package. Interventions and services related to breast cancer included radiographic procedures, laboratory and imaging tests, chemotherapy drugs and medications, medical and surgical supplies, surgical rates (for breast surgery), accommodation, staff time and salary/professional fees, and other procedure fees. The study conducted in 2022, examined cost prices of breast cancer interventions and services from stage 1–3B.

Purposive and convenience sampling were used based on PhilHealth accreditation and willingness of hospitals to participate in the study. The study conducted a focus group discussion with oncologists, radiologists, anesthesiologists, and other health care providers to validate the clinical guideline used and to solicit inputs to the costing design, analysis framework, and tools for data collection. Data collection of financial cost information (charge price) was conducted using a set of costing matrices filled out by the various departments of the hospitals. Costs and median rates were calculated across hospitals on diagnostics and imaging tests, surgery costs of both public and private facilities, medical treatment, and radiotherapy.

RESULTS

Breast MRI, Breast Panel, and Chest CT Scan are the top 3 most expensive diagnostic procedures ranging from PhP 8,102.00 to PhP 9,800.00 per procedure. Surgical procedures for breast cancer at private hospitals and public hospitals showed huge differences in costs. The cost of a cycle of chemotherapy ranges from PhP 596.70 to PhP 3,700.00 per session, while the cost of targeted therapy can cost up to PhP 46,394.21 per session. A year of hormone therapy ranges from PhP 3,276.00 with the use of Tamoxifen, and up to PhP 68,284.00 with Goserelin. Aromatase inhibitors such as Anastrozole and Letrozole cost from PhP 18,000 to PhP 36,000, respectively. Multiple cycles depending on the diagnosis are prescribed per patient and used in combination with other chemotherapy medications or other therapies such as targeted therapy and hormone therapy are usually taken daily up to 5 to 10 years. Conventional radiotherapy can cost up to PhP 88,150.00 covering 28 sessions, CT simulation, and CT planning.

CONCLUSION

This cost study provides relevant information and better perspective on benefit development for the PHIC, policy development for Department of Health on where and how to focus their support for the patient’s financial preparedness to address medical and f inancial catastrophes.

PhilHealth needs to guide the health care providers of their costing method and to develop their own integrated, interoperable, and comprehensive cost data library.

It recommends that the government allocate budget and cover for screening and assessment for earlier stage diagnosis of patients and lower health expenditure costs on cancer treatment.

Human ; Breast Neoplasms ; Drug Therapy ; Chemotherapy ; Mastectomy ; Radiotherapy ; Radiation Therapy

Child ; Emergency Service, Hospital ; Hospitals, Pediatric ; Humans ; Mass Screening

No abstract available.
Medical Oncology*

The ovary of Haemaphysalis bispinosa was of panoistic type with asynchronous development of oocytes. The wall of the ovary was composed of a layer of epithelial cells to which the oocytes were attached by means of pedicel cells with elongated nucleus. The oocytes were classified into stages I to V based on morphologic characteristics like size and shape, presence / absence of germ vesicle, cytoplasmic appearance, presence or absence of yolk granules and presence of chorion. Day wise changes were in the form of occurrence of oogonia from partially fed upto day zero of engorgement, presence of all stages of oocytes on day one and two after engorgement and onset of degenerative changes in oocytes from day three onwards. Degeneration was complete on day eight with the appearance of polymorphism, vacuolation, cytoplasmic blebbing and autophagic activity in oocytes.

As per the report published by FAO (2004), the tick population in India has developed resistance against all the available acaricides. Hence, newer methods of control including potential herbal agents are required to reduce the problems caused by the ticks. Most of the herbal extracts or their fractions are dissolved in polar or non-polar solvents or detergents before tested for acaricidal activity and these diluents should be of little acaricidal activity. In the present study, adult immersion test (AIT) was carried out on adult engorged female Haemaphysalis bispinosa ticks to detect the acaricidal activity of different solvents viz., nbutanol, glycerol, acetone, ethanol, methanol and surfactants (at 1 per cent dilution) like dimethyl sulphoxide (DMSO), tween 20 and triton X- 100. The study revealed that methanol was the least toxic solvent while tween 20 (1 per cent) was the least toxic detergent against H. bispinosa.