This research article, published in Cancer Medicine in 2025, presents a comprehensive, real-life report on the healthcare expenditure associated with lung carcinoma in Turkey, drawing data from a prominent tertiary pulmonology center. Authored by Kerem Ensarioğlu, Berna Akıncı Özyürek, Metin Dinçer, and Hızır Alı Gümüşler, the study addresses a critical gap in available literature regarding the economic burden of lung cancer within Turkey’s national healthcare system.
Lung cancer stands as the most common carcinoma globally and is the leading cause of cancer-related deaths worldwide, accounting for an estimated 2.5 million new cases in 2023. This dire situation is mirrored in Turkey, where lung cancer also remains the most frequently observed cancer type with the highest overall mortality. The combined mortality from “larynx and trachea/bronchus/lung neoplasm” represented a significant portion of deaths from malignant neoplasms in Turkey, at 29.7% in 2021 and 29.4% in 2022.
The global burden of lung cancer is continuously rising due to factors such as population growth, aging populations, and increasing prevalence of risk factors like smoking and air pollution. This trend places immense strain on healthcare systems worldwide. Internationally, lung malignancies impose a substantial socioeconomic burden, as evidenced by reports from the United States and the European Union. For instance, in the USA, lung cancer was linked to a loss of 21.3 billion USD in workforce out of a total 94.4 billion USD attributed to all cancer-related losses. Similarly, in the EU, lung carcinoma accounts for the leading healthcare expenditure among all cancers, consuming 18.8 billion euros (15%) out of a 126 billion euro budget. Despite this significant global impact, there has been a notable lack of definitive data concerning lung carcinoma and related expenditure specifically within Turkey. This study directly addresses this void, offering crucial insights into the real-world costs of managing lung cancer within the Turkish national healthcare framework.
Methodology:
The study retrospectively analyzed data from patients evaluated at a tertiary hospital specializing in pulmonary medicine between 2013 and 2022. The initial dataset comprised 199,112 patient admissions reimbursed under the national healthcare insurance system. After rigorous exclusion criteria, including the removal of repeated admissions, irrelevant data, and patients who received care solely on an outpatient basis, 4,991 unique patients were included in the final analysis. The rationale for excluding outpatient-only patients was tied to Turkey’s reimbursement system, which often requires at least one inpatient day for diagnostic procedures.
Data collection for each patient included demographic information, specific malignancy types (categorized as Non-Small Cell Lung Carcinoma (NSCLC) – including Squamous Cell Carcinoma (SCC) and Adenocarcinoma – Small Cell Lung Carcinoma (SCLC), carcinoid tumors, large cell carcinoma, and malignant epithelioma), diagnostic methods employed (such as surgical, transthoracic needle aspiration, and endobronchial ultrasonography), and various treatment modalities (chemotherapy, radiotherapy, palliative care, and antibiotic regimens). Lung carcinoma staging was simplified into four main categories: local, locally advanced, advanced, and metastatic, which was deemed adequate for the study’s statistical and expenditure purposes. All expenditure data, originally in Turkish Lira (TL), were converted to United States Dollars (USD) using the yearly exchange rates provided by the Central Bank of the Republic of Turkey, aiming to standardize the cost evaluation over the ten-year period. Statistical analysis was performed using IBM SPSS Version 25th, employing descriptive analysis, Mann–Whitney U, and chi-square tests, with p-values at or below 0.05 considered statistically significant.
Key Findings:
The study provided significant insights into the financial burden of lung cancer in Turkey:
- Average Healthcare Expenditure: The average healthcare expenditure per patient diagnosed with lung malignancy during the treatment duration was 4289.4 (± 3739.4) USD, with a median expenditure of 3219.9 USD.
- Patient Demographics: The study population was predominantly male (88.3%), with an average age of 70.2 years. NSCLC was the most common subtype (85% of lung carcinoma), with SCC (36.9%) and adenocarcinoma (29.2%) being the most prevalent within NSCLC, while SCLC constituted 20.9% and carcinoid tumors were the rarest (0.4%). Most patients (61.2%) were diagnosed at an advanced stage or metastatic (18.3%).
- Factors Influencing Expenditure:
- Gender: Male patients incurred a higher average expenditure (median 3260 USD) compared to female patients (median 2977 USD). Male patients also had longer hospitalization durations.
- Survival Status: Survivors demonstrated an overall lower healthcare expenditure (median 2865 USD) than the non-survivor group (median 4230 USD).
- Stage at Diagnosis: Patients with a locally advanced disease classification had the highest expenditure (median 5799.2 USD) compared to other stages. This observation held true across most malignancy subtypes, being particularly prominent in SCC and adenocarcinoma.
- Malignancy Subtype and Stage Interaction:
- SCLC was a notable exception regarding stage, as it showed the highest expenditure at the limited stage (median 5796.6 USD), which is attributed to the more palliative approach and limited treatment modalities available for SCLC as the disease progresses.
- Carcinoid tumors consistently had the least expenditure at both limited and advanced stages compared to other subtypes.
- At the locally advanced stage, large cell carcinoma, SCC, and adenocarcinoma required the highest expenditure.
- Diagnosis Difficulty: The non-diagnostic patient group (those for whom a definitive diagnosis could not be reached despite interventions) had an overall higher healthcare expenditure and longer hospitalization durations, reflecting the increased costs associated with repeated diagnostic interventions.
- Hospitalization: A longer duration of hospitalization (mean 33 days, median 26 days) and treatment provided on an inpatient basis significantly contributed to higher costs. A strong positive correlation (Rho = 0.660) was observed between total admission days and healthcare expenditure.
- Age: While age was identified as a parameter affecting overall cost, a very weak negative correlation (Rho = −0.155) was found between age and total healthcare expenditure.
- Treatment Location: Patients requiring solely inpatient care incurred nearly double the expenditure compared to those receiving both inpatient and outpatient care, supporting the notion that hospitalization was required for more intensive procedures and complications.
Conclusion and Implications:
The study clearly identifies several critical parameters influencing the overall cost of lung cancer care in Turkey: age, gender, disease stage, and malignancy subtype. It underscores how the impact of stage on cost can vary significantly depending on the specific malignancy subtype, as seen with SCLC. The findings also highlight the economic burden posed by diagnostic challenges, with patients in the non-diagnostic group facing higher costs. Furthermore, a longer duration of hospitalization and inpatient treatment were consistently associated with increased healthcare expenditure.
The researchers emphasize that early disease control remains paramount for managing overall healthcare expenditure, particularly for NSCLC. While this was less evident for SCLC, they still advocate for early diagnosis as essential not only for patient health outcomes but also for the economic benefit of the healthcare system. Ultimately, the study concludes that the prevention of lung malignancy, notably through smoking cessation strategies, is the most optimal, reliable, and least expensive method to significantly reduce the healthcare burden and expenditure associated with this pervasive disease.
Reference: Ensarioğlu, K., Akıncı Özyürek, B., Dinçer, M., & Gümüşler, H. A. (2025). Reimbursement of Lung Cancer in Turkey: A 10‐Year Single Center Study. Cancer Medicine.