Costs analysis of radiotherapy for breast cancer in Indonesia: a comparison between reimbursement tariffs and actual costs

Background: Breast cancer is the most common cancer in Indonesia, and radiotherapy plays an essential role in its treatment. However, since 2016, the INA-CBGs (Indonesian Case-Based Groups) tariffs for radiotherapy have remained unchanged. This study aimed to assess the disparity between tariffs and actual costs of outpatient radiotherapy in breast cancer, using real-world data from two Indonesian hospitals.

Methods: We conducted a retrospective cohort study in a national public referral hospital and a private hospital. Breast cancer claims data were collected from 2017 to 2022 from the Department of Accounting/Finance with INA-CBGs tariff code of C-3-10-0 (radiotherapy procedures for outpatients). We estimated total actual costs, actual costs per patient and visit, and the cost-tariffs ratio. Differences between the actual costs and tariffs were analyzed using Mann-Whitney test.

Results: A total of 3,890 breast cancer patients were included in the study, of which 74.4% were from the national public referral hospital. In the national public referral hospital and private hospital, the total actual costs of outpatient radiotherapy in breast cancer were USD 19,028,791.17 and USD 5,279,980.74, with median costs per patient of USD 6,560.00 [3,679.81;7,518.46] and USD 5,110.00 [839.15;7,552.34], and median costs per visit of USD 272.00 [253.16;274.47] and USD 272.00 [211.31;305.50], respectively. Over the study period, the cost-tariffs ratio was 86.85% and 59.07% in the national public referral hospital and private hospital, respectively. The differences between the tariffs and total actual costs were statistically significant in both hospitals and increased throughout the years.

Conclusions: For both hospitals, the INA-CBGs tariffs for outpatient radiotherapy services for breast cancer were insufficient to fully cover the actual costs during the review period. Furthermore, the difference between the tariffs and the actual costs increased over the years, emphasizing the need for revision of the C-3-10-0 tariffs. It is crucial to ensure coverage of all actual costs to ensure the sustainability, accessibility, and availability of radiotherapy treatment for breast cancer patients in Indonesia.