The analysis of medical costs according to the stages of colorectal cancer using health insurance claims

2023 Fiscal Year Final Research Report

• Project/Area Number: 22K21080
• Research Category: Grant-in-Aid for Research Activity Start-up
• Allocation Type: Multi-year Fund
• Review Section: 0908:Society medicine, nursing, and related fields
• Research Institution: Kyoto University
• Principal Investigator: Utsumi Takahiro 京都大学, 医学研究科, 医員 (10963332)
• Project Period (FY): 2022-08-31 – 2024-03-31
• Keywords: 医療費 / 大腸がん / 診療報酬明細書 / がん登録 / 進行度

Outline of Final Research Achievements

It is important to ascertain the efficacy for reducing medical costs through the early detection of colorectal cancer (CRC). The actual medical costs according to stages of CRC should be examined before assessing its efficacy. In our study, we developed an algorithm to identify patients with CRC and determine CRC stages using the information of claims data. The sensitivity and PPV of our algorithm for identifying patients with invasive CRC exceeded 90%, and the agreement for identifying the stages of CRC patients also exceeded 90%. We adopted the algorithm to the large-scale claims database. The algorithm allowed the identification of CRC patients and its actual medical costs according to CRC stage using real-world data. Additionally, we calculated the medical costs according to CRC stage using claims data linked to hospital-based cancer registry at a single institution. We found no problem with this attempt.

Free Research Field

消化器内科

Academic Significance and Societal Importance of the Research Achievements

診療報酬明細書（レセプト）から医療費の算出は可能だが、レセプトに記載される傷病名のみでは正確ながん患者やその進行度の同定はできず、がん患者の実際の医療費の検討は困難であった。今回、我々が作成したアルゴリズムをレセプトに適応することで、高い精度で大腸がん患者とその進行度を同定することができ、大腸癌患者の医療費にとどまらず、レセプトに記載される診療行為からがん診療の実態を明らかにできると期待される。また、今後、がん登録とNational Databaseの突合が可能になればがん診療における医療費の算出が可能であることも示すことができた。