Cost determinant of chemotherapy in breast, cervical, and lung cancer in the era of National Health Insurance

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Fitriana Yuliastuti
Tri Murni Andayani
Dwi Endarti
Susi Ari Kristina


cancer treatment, breast cancer, cervical cancer, lung cancer, healthcare costs


Introduction: This study focuses on the financial burden of treating breast, cervical, and lung cancer in Indonesia. The prevalence and mortality rates of this cancer, particularly in the context of the National Health Insurance program, are highlighted. The financial strain created by cancer treatment, its relationship to Universal Health Coverage goals, and the impact of the JKN initiative are discussed. Novelty: The originality of the study lies in exploring patient profiles, disease severity, and associated expenses, culminating in a comprehensive evaluation of medical expenses. Methods: This study used an analytic observational approach with a cross-sectional design, centered on the perspective of the Dharmais Cancer Center Hospital. The population consists of JKN patients diagnosed with breast, cervical and lung cancer. Data were collected retrospectively from JKN claim files and medical device records. Quantitative studies were conducted to understand the components of real costs, variations of chemotherapy, and the determinants of differences in costs. Statistical tests were used for data analysis. Results: This study involved 348 breast cancer patients, 306 cervical cancer patients, and 176 lung cancer patients undergoing chemotherapy in 2020. The distribution of patients by age group and cancer type was analysed, and disease characteristics were categorized by stage and severity using the Indonesian Case Base Groups (INA-CBGs) code. The cost analysis reveals the importance of accommodation, medicines, and medical equipment in terms of the overall expenditure. The cost of chemotherapy is very influential, and different treatment regimens are being explored for each type of cancer. Conclusion: This study underscores the important role of chemotherapy drugs, pharmaceutical costs, and medical devices in driving the overall cost of care. These insights contribute to informed decision making in healthcare policy and patient management, potentially reducing the financial burden faced by cancer patients. Recommendation: Further research and interventions can be designed based on these findings to optimize cancer treatment strategies and resource allocation.

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1. IARC. Indonesia - Global Cancer Observatory. Globocan. 2020;858:1-2.
2. Fatonah S, Yulandari A, Wibowo FW. A Review of E-Payment System in E-Commerce. Journal of Physics: Conference Series. 2018;1140(1).
3. Dewi BA, Oetari O, Andayani TM. Cost Compliance Analysis of Real Therapy and INA-CBG’s of Chemotherapy Breast Cancer Inpatien At 2017 Dr. Moewardi Surakarta Hospital. STRADA Jurnal Ilmiah Kesehatan. 2021;10(1):1234-41.
4. Utami M. Upaya Indonesia Capai Universal Health Coverage di Tahun 2019. sehatnegeriku.kemkes. 2018.
5. Hofmarcher T, Lindgren P, Wilking N, et al. The cost of cancer in Europe 2018. European Journal of Cancer. 2020;129:41-9.
6. Oktafiani E, Herowati R, Andayani TM. Analisis Biaya Riil Dan Kesesuaian Dengan Tarif INA-CBGs Pada Pasien Kanker Ovarium RS Di Kota Surakarta Tahun 2018 Analysis Real Cost And Compatibility With INA-CBGs Tariff Ovarian Cancer Patient In General Hospital Surakarta 2018 Kanker ovarium menurut . 2020;17(02):156-65.
7. Senapati S, Mahanta AK, Kumar S, et al. Controlled drug delivery vehicles for cancer treatment and their performance. Signal transduction and targeted therapy. 2018;3:7.
8. Dolgin E. Bringing down the cost of cancer treatment. Nature [Internet]. 2018 Aug 20;555:S26+. Available from: https://link.
9. Riera R, Bagattini ÂM, Pacheco RL, et al. Delays and disruptions in cancer health care due to COVID-19 pandemic: systematic review. JCO Global Oncology. 2021;7(1):311-23.
10. Solikhah S, Matahari R, Utami FP, et al. Breast cancer stigma among Indonesian women: A case study of breast cancer patients. BMC Women’s Health. 2020;20(1):1-5.
11. Stallworthy G, Dias HM, Pai M. Quality of tuberculosis care in the private health sector. Journal of clinical tuberculosis and other mycobacterial diseases. 2020;20:100171.
12. Mulyanto J, Kringos DS, Kunst AE. Socioeconomic inequalities in healthcare utilisation in Indonesia: a comprehensive surveybased overview. BMJ open. 2019;9(7):e026164.
13. Arini M, Sugiyo D, Permana I. Challenges, opportunities, and potential roles of the private primary care providers in tuberculosis and diabetes mellitus collaborative care and control: a qualitative study. BMC Health Services Research. 2022;22(1):215.
14. Satibi dkk. Analisis of Factors Influencing the Availability of Medicine During JKN Era. 2018;29(1):37-43.
15. Yuliastuti F, Andayani TM, Endarti D, et al. Breast, cervical, and lung cancer: A comparison of real healthcare costs and INA-CBGs rates in the era of national health insurance. Pharmacy Practice. 2023;21(1):1-7. pharmpract.2023.1.2768
16. Fathoni MIA, Gunardi, Adi-Kusumo F, et al. Characteristics of breast cancer patients at dr. Sardjito Hospital for early anticipation of neutropenia: Cross-sectional study. Annals of Medicine and Surgery. 2022;73:103189. amsu.2021.103189
17. Kementerian Kesehatan RI. Pedoman Nasional Pelayanan Kedokteran : Kanker payudara. 2017;
18. Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia 2016. Profil Kesehatan Provinsi Bali. 2016. 1-220 p.
19. Mostert S, Njuguna F, van de Ven PM, et al. Influence of health-insurance access and hospital retention policies on childhood cancer treatment in Kenya. Pediatric Blood and Cancer. 2014;61(5):913-8.
20. Nguyen VT, Winterman S, Playe M, et al. Dose-Intense Cisplatin-Based Neoadjuvant Chemotherapy Increases Survival in Advanced Cervical Cancer: An Up-to-Date Meta-Analysis. Cancers. 2022;14(3).
21. Indriani D, Kusnanto H, Ghufron Mukti A, et al. The Effect of Laboratory Cost to Gap Price Between INA-CBGs Reimbursement and Itemized Bill in Leukemia Diagnosis. Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal). 2013;7(10):440-6.
22. Hu L, Li L, Ji J, et al. Identifying and understanding determinants of high healthcare costs for breast cancer: a quantile regression machine learning approach. BMC health services research. 2020;20(1):1-10.
23. Al. LHwClL et. Cost Efectiveness of PD‑L1‑Based Test‑and‑Treat Strategy with Pembrolizumab as the First‑Line Treatment for Metastatic NSCLC in Hong Kong. Hong Kong: PharmacoEconomics; 2019. p. 235-46. 00178-7
24. Ward RL, Laaksonen MA, van Gool K, et al. Cost of cancer care for patients undergoing chemotherapy: The Elements of Cancer Care study. Asia-Pacific journal of clinical oncology. 2015;11(2):178-86.
25. Martin M, Pienkowski T, Mackey J, et al. Adjuvant docetaxel for node-positive breast cancer. The New England journal of medicine. 2005;352(22):2302-13.
26. Federico C, Sun J, Muz B, et al. Localized Delivery of Cisplatin to Cervical Cancer Improves Its Therapeutic Efficacy and Minimizes Its Side Effect Profile. International journal of radiation oncology, biology, physics. 2021;109(5):1483-94. https://
27. Joerger M, Ess S, Dehler S, et al. A population-based study on the patterns of use of different chemotherapy regimens in Swiss patients with early breast cancer. Swiss medical weekly. 2012;142:w13571.
28. Chu G, Liu X, Yu W, et al. Cisplatin plus paclitaxel chemotherapy with or without bevacizumab in postmenopausal women with previously untreated advanced cervical cancer: a retrospective study. BMC cancer. 2021;21(1):133. s12885-021-07869-7
29. Gervais R, Robinet G, Clément-Duchêne C, et al. Pemetrexed and carboplatin, an active option in first-line treatment of elderly patients with advanced non-small cell lung cancer (NSCLC): a phase II trial. Lung cancer (Amsterdam, Netherlands). 2013;80(2):185-90.
30. Yuliastuti F, Kristina SARI, Endarti DWI, et al. A Systematic Review of Cost Effectiveness of Pembrolizumab Versus Standard Treatment for Metastatic Non-Small Cell Lung Cancer. International Journal of Pharmaceutical Research. 2021;13(02). https://