Medical care costs incurred by patients with smoking-related non-small cell lung cancer treated at the National Cancer Institute of Mexico
More details
Hide details
Clinic of Thoracic Oncology, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
Medical Oncology Department, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
Tobacco Control Research Department, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
Head of the Epidemiology Unit, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
National Autonomous University of Mexico (UNAM), Mexico City, Mexico
Luz Myriam Reynales-Shigematsu   

Tobacco Control Research Department, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
Submission date: 2014-05-30
Acceptance date: 2014-12-05
Publication date: 2015-02-04
Tobacco Induced Diseases 2014;12(February):25
Smoking is a public health problem in Mexico and worldwide; its economic impact on developing countries has not been well documented. The aim of this study was to assess the direct medical costs attributable to smoking incurred by lung cancer patients treated at the National Cancer Institute of Mexico (INCan).

The study was conducted at INCan in 2009. We carried out a cost of illness (COI) methodology, using data derived from an expert panel consensus and from medical chart review. A panel of experts developed a diagnostic-therapeutic guide that combined the hospital patient pathways and the infrastructure, human resources, technology, and services provided by the medical units at INCan. Cost estimates in Mexican pesos were adjusted by inflation and converted into US Dollars using the 2013 FIX exchange rate for foreign transactions (1 USD = 13.06 Mexican pesos).

A 297 incident cases diagnosed with any type of lung cancer were analyzed. According to clinical stage, the costs per patient were 13,456; 35,648; 106,186; and 144,555 USD, for lung cancer stages I, II, III, and IV respectively. The weighted average annual cost/patient was and 139,801 USD and the average annual cost/patient that was attributable to smoking was 92,269 USD. This cost was independent of the clinical stage, with stage IV representing 96% of the annual cost. The total annual cost of smoking-related lung cancer at INCan was 19,969,781 USD.

The medical care costs of lung cancer attributable to smoking represent a high cost both for INCan and the Mexican health sector. These costs could be reduced if all provisions established in the Framework Convention of Tobacco Control of the World Health Organization were implemented in Mexico.

Eriksen M, MacKay J, Ross H: The tobacco atlas. American Cancer Society: Atlanta; 2013.
Mathers CD, Loncar D: Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006, 3(suppl):e442.
Centers for Disease Control and Prevention (CDC): Smoking-attributable mortality, years of potential life lost, and productivity losses--United States, 2000-2004. MMWR Morb Mortal Wkly Rep 2008, 57:1226–1228.
Callum C, Boyle S, Sandford A: Estimating the cost of smoking to the NHS in England and the impact of declining prevalence. Health Econ Policy Law 2011, 6:489–508.
Ruff LK, Volmer T, Nowak D, Meyer A: The economic impact of smoking in Germany. Eur Respir J 2000, 16:385–390.
Neubauer S, Welte R, Beiche A, Koenig HH, Buesch K, Leidl R: Mortality, morbidity and costs attributable to smoking in Germany: update and a 10-year comparison. Tob Control 2006, 15:464–471.
Banegas JR, Diez-Gañan L, Bañuelos-Marco B, González-Enríquez J, Villar-Álvarez F, Martín-Moreno JM, Córdoba-García R, Pérez-Trullén A, Jiménez-Ruiz C: Mortalidad atribuible al consumo de tabaco en España en 2006. Med Clinc (Barc) 2011, 136:97–102.
Jimenez-Ruiz JA, Saenz de Miera B, Reynales-Shigematsu LM, Waters HR, Hernández-Avila M: The impact of taxation on tobacco consumption in Mexico. Tob Control 2008, 17:105–110.
Siegel R, Naishadmham D, Jemal A: Cancer Statistics, 2013. CA Cancer J Clin 2013, 59:225–249.
GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. [].
American Cancer Society: Cancer Facts and Figures 2012. Atlanta: American Cancer Society; 2012.
The MPOWER package: WHO report on the global tobacco epidemic. Geneva: World Health Organization; 2008.
Ruiz-Godoy L, Rizo Rios P, Sanchez-Cervantes F, Osornio-Vargas A, García-Cuellar C, Meneses García A: Mortality due to lung cancer in Mexico. Lung Cancer 2007, 58:184–190.
Valdes N, Sanchez S: El tabaco y las adolescentes: tendencias actuales. Organizacion Panamericana de la Salud: Washington; 1999.
Medina F, Salazar M: Frecuencia y patron cambiante del cancer pulmonar en Mexico. Salud Publica de Mex 2000, 42:333–336.
Lazcano-Ponce E, Reynales-Shigematsu LM, Guerrero-López CM, Vallejo-Mateos A, Muños-Hernández JA, BarrientosGutiérrez T, Thrasher-La Fontaine J, Arillo-Santillán E, Pérez-Hernández R, Sáenz-de-Miera-Juárez B: Encuesta Nacional de Adicciones 2011: tabaco. Cuernavaca, México: Instituto Nacional de Salud Pública, 2013.
Arrieta O, Guzman-de Alba E, Alba-Lopez LF, Acosta-Espinoza A, Alatorre-Alexander J, Alexander-Meza JF, Allende-Pérez SR, Alvarado-Aguilar S, Araujo-Navarrete ME, Argote-Greene LM, Aquino-Mendoza CA, Astorga-Ramos AM, Austudillo-de la Vega H, Avilés-Salas A, Barajas-Figueroa LJ, Barroso-Quiroga N, Blake-Cerda M, Cabrera-Galeana PA, Calderillo-Ruíz G, Campos-Parra AD, Cano-Valdez AM, Capdeville-García D, Castillo-Ortega G, Casillas-Suárez C, Castillo-González P, Corona-Cruz JF, Correa-Acevedo ME, Cortez-Ramírez SS, de la Cruz-Vargas JA, de la Garza-Salazar JG, et al: Consenso nacional de diagnostico y tratamiento del cancer de pulmon de celulas no pequeñas. Rev Invest Clin 2013, 65(Suppl):S5–S84.
Arrieta O, Campos-Parra AD, Zuloaga C, Avilés A, Sánchez-Reyes R, Manríquez ME, Covián-Molina E, Martínez-Barrera L, Meneses A, Cardona A, Borbolla-Escoboza JR: Clinical and pathological characteristics, outcome and mutational profiles regarding non-small-cell lung cancer related to wood-smoke exposure. J Thorac Oncol 2012, 7:1228–1234.
Lazcano Ponce EC, Tovar Guzman V, Meneses Gonzalez F, Rascon Pacheco RA, Hernandez Avila M: Trends of lung cancer mortality in Mexico. Arch Med Res 1997, 28:565–570.
Medina FM, Barrera RR, Morales JF, Echegoyen RC, Chavarría JG, Rebora FT: Primary lung cancer in Mexico city: a report of 1019 cases. Lung Cancer 1996, 14:185–193.
Carlson JJ, Veenstra DL, Ramsey SD: Pharmacoeconomic evaluations in the treatment of non-small cell lung cancer. Drugs 2008, 68:1105–1113.
Campos-Parra AD, Cruz-Rico G, Arrieta O: Personalized treatment in non-small cell lung cancer. Rev Invest Clin 2012, 64:377–386.
Jäkel A, Plested M, Dharamshi K, Modha R, Bridge S, Johns A: A systematic review of economic evaluations in second and later lines of therapy for the treatment of non-small cell lung cancer. Appl Health Econ Health Policy 2013, 11:27–43.
Zeng X, Karnon J, Wang S, Wu B, Wan X, Peng L: The cost of treating advanced non-small cell lung cancer: estimates from the chinese experience. PLoS One 2012, 7:e48323.
Sobin LH, Wittekind C: TNM Classification of Malignant Tumours. New York: International Union Against Cancer/Wiley-Blackwell; 2002.
Fink A, Kosecoff J, Chassin M, Brook RH: Consensus methods: characteristics and guidelines for use. Am J Public Health 1984, 74:979–983.
Eisenberg JM: Clinical economics. A guide to the economic analysis of clinical practices. JAMA 1989, 262:2879–2886.
Oostenbrink JB, Koopmanschap MA, Rutten FF: Standardisation of costs: the Dutch manual for costing in economic evaluations. Pharmacoeconomics 2002, 20:443–454.
Jones J, Hunter D: Consensus methods for medical and health services research. BMJ 1995, 311:376–380.
Mogyorosy Z, Smith P: The main methodological issues in costing health care services: a literature review. York: The University of York Centre for Health Economics; 2005.
Drummond M, O’Brien B, Stoddart GL, Torrance GW: Metodos para la evaluación económica de los programas de asistencia sanitaria. Madrid: Ediciones Diaz de Santos; 2001.
Llorca J, Fariñas-Alvarez C, Delgado-Rodriguez M: Fraccion atribuible poblacional: calculo e interpretacion. Gac Sanit 2001, 15:61–67.
Warner KE, Hodgson TA, Carroll CE: Medical costs of smoking in the United States: estimates, their validity, and their implications. Tob Control 1999, 8:290–300.
Jha P, Chaloupka F: Tobacco Control in Developing Countries. Oxford: Oxford University Press; 2000.
Research for International Tobacco Control. At what cost? The economic impact of tobacco use on national health systems, societies and individuals: a summary of methods and findings. Ottawa: RITC Monograph Series No. 1, International Development Research Centre, 2003.
Reynales-Shigematsu LM, Rodriguez-Bolaños Rde L, Jiménez JA, Juárez-Márquez SA, Castro-Ríos A, Hernández-Avila M: Health care costs attributable to tobacco consumption on a national level in the Mexican Social Security Institute. Salud Publica Mex 2006, 48(Suppl):S48–S64.
Reynales LM, Thrasher JF, Lazcano E, Hernandez M: Salud publica y tabaquismo, volumen I. Politicas para el control del tabaco en Mexico. Mexico: Instituto Nacional de Salud Publica; 2012.
Samet JM: Tobacco smoking: the leading cause of preventable disease worldwide. Thorac Surg Clin 2013, 23:103–112.
Dresler C: The changing epidemic of lung cancer and occupational and environmental risk factors. Thorac Surg Clin 2013, 23:113–122.
Instituto Nacional de Estadística, Geografía e Informática, 2009. [].
Arrieta O, Martinez-Barrera L, Treviño S, Guzman E, Castillo-Gonzalez P, Rios-Trejo MA, Flores-Estrada D, Téllez E, Gonzalez C, de la Cruz Vargas J, la Rosa CH G-D, Hernandez-Pedro N, Morales-Barrera R, De la Garza J: Wood-smoke exposure as a response and survival predictor in erlotinib-treated non-small cell lung cancer patients. J Thorac Oncol 2008, 3:887–893.
Bosetti C, Rodriguez T, Chatenoud L, Bertuccio P, Levi F, Negri E, La Vecchia C: Trends in cancer mortality in Mexico, 1981-2007. Eur J Cancer Prev 2011, 20:355–363.
Yu YH, Liao CC, Hsu WH, Chen HJ, Liao WC, Muo CH, Sung FC, Chen CY: Increased lung cancer risk among patients with pulmonary tuberculosis: a population cohort study. J Thorac Oncol 2011, 6:32–37.
Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, Cooper D, Gansler T, Lerro C, Fedewa S, Lin C, Leach C, Cannady RS, Cho H, Scoppa S, Hachey M, Kirch R, Jemal A, Ward E: Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 2012, 62:220–241.
Jemal A, Center MM, DeSantis C, Ward EM: Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 2010, 19:1893–1907.
Arrieta O, Cardona AF, Federico Bramuglia G, Gallo A, Campos-Parra AD, Serrano S, Castro M, Avilés A, Amorin E, Kirchuk R, Cuello M, Borbolla J, Riemersma O, Becerra H, Rosell R, CLICaP: Genotyping non-small cell lung cancer (NSCLC) in Latin America. J Thorac Oncol 2011, 6:1955–1959.
Campos-Parra AD, Zuloaga C, Manriquez ME, Avilés A, Borbolla-Escoboza J, Cardona A, Meneses A, Arrieta O: KRAS Mutation as the biomarker of response to chemotherapy and EGFR-TKIs in patients with advanced non-small cell lung cancer: clues for its potential use in second-line therapy decision making. Am J Clin Oncol, in press.
Korf BR, Rehm HL: New approaches to molecular diagnosis. JAMA 2013, 309:1511–1521.
Yao S, Zhu Y, Chen L: Advances in targeting cell surface signaling molecules for immune modulation. Nat Rev Drug Discov 2013, 12:130–146.
Chung C, Christianson M: Predictive and prognostic biomarkers with therapeutic targets in breast, colorectal, and non-small cell lung cancers: a systemic review of current development, evidence, and recommendation. J Oncol Pharm Pract 2014, 20:11–28.
Li T, Kung HJ, Mack PC, Gandara DR: Genotyping and genomic profiling of non-small-cell lung cancer: implications for current and future therapies. J Clin Oncol 2013, 31:1039–1049.
Cagle PT, Allen TC: Lung cancer genotype-based therapy and predictive biomarkers: present and future. Arch Pathol Lab Med 2012, 136:1482–1491.
Minimum Wages Laws in the States – Wage and Hour Division. United States Department of Labor. [].
Salarios Minimos – 2014. Servicio de Administracion Tributaria. [].
Hatsukami DK, Stead LF, Gupta PC: Tobacco addiction. Lancet 2008, 371:2027–2038.
Valdes-Salgado R, Lazcano-Ponce EC, Hernandez-Avila M: Primer Informe sobre el combate al tabaquismo. Mexico ante el Convenio Marco para el Control del Tabaco. Cuernavaca: Instituto Nacional de Salud Pública; 2005.
Tindle HA, Shiffman S, Hartman AM, Bost JE: Switching to “lighter” cigarettes and quitting smoking. Tob Control 2009, 18:485–490.
Difranza JR, Savageau JA, Fletcher K, O'Loughlin J, Pbert L, Ockene JK, McNeill AD, Hazelton J, Friedman K, Dussault G, Wood C, Wellman RJ: Symptoms of tobacco dependence after brief intermittent use. Arch Pediatr Adolesc Med 2007, 161:704–710.
Reynales-Shigematsu LM, Campuzano-Rincon JC, Sesma-Vazquez S, Juárez-Márquez SA, Valdés-Salgado R, Lazcano-Ponce E, Hernández-Avila M: Costs of medical care for acute myocardial infarction attributable to tobacco consumption. Arch Med Res 2006, 37:871–879.
From sperm to offspring: Assessing the heritable genetic consequences of paternal smoking and potential public health impacts
Marc A. Beal, Carole L. Yauk, Francesco Marchetti
Mutation Research/Reviews in Mutation Research
Cost-effectiveness analysis of EGFR mutation testing in patients with non-small cell lung cancer (NSCLC) with gefitinib or carboplatin–paclitaxel
Oscar Arrieta, Pablo Anaya, Vicente Morales-Oyarvide, Laura Alejandra Ramírez-Tirado, Ana C. Polanco
The European Journal of Health Economics
Economic burden of resected (stage IB-IIIA) non-small cell lung cancer in France, Germany and the United Kingdom: A retrospective observational study (LuCaBIS)
Stefan Andreas, Christos Chouaid, Sarah Danson, Obukohwo Siakpere, Laure Benjamin, Rainer Ehness, Marie-Hélène Dramard-Goasdoue, Janina Barth, Hans Hoffmann, Vanessa Potter, Fabrice Barlesi, Costel Chirila, Kelly Hollis, Carolyn Sweeney, Mark Price, Sorrel Wolowacz, James A. Kaye, Ilias Kontoudis
Lung Cancer
Real-World Treatment Patterns, Survival, and Prediction of CNS Progression in ALK-Positive Non-Small-Cell Lung Cancer Patients Treated with First-Line Crizotinib in Latin America Oncology Practices
Claudio Martín, Andrés F. Cardona, Zyanya Lucia Zatarain-Barrón, Alejandro Ruiz-Patiño, Omar Castillo, George Oblitas, Luis Corrales, Lorena Lupinacci, María Angelina Pérez, Leonardo Rojas, Lisde González, Luis Chirinos, Carlos Ortíz, Mauricio Lema, Carlos Vargas, Carmen Puparelli, Hernán Carranza, Jorge Otero, Oscar Arrieta
Lung Cancer in Mexico
Oscar Arrieta, Zyanya Zatarain-Barrón, Fernando Aldaco, Feliciano Barrón, Renata Báez-Saldaña, Saúl Campos-Gómez, Rogelio Trejo, la De
Journal of Thoracic Oncology
Cost-effectiveness analysis of first and second-generation EGFR tyrosine kinase inhibitors as first line of treatment for patients with NSCLC harboring EGFR mutations
Oscar Arrieta, Rodrigo Catalán, Silvia Guzmán-Vazquez, Feliciano Barrón, Luis Lara-Mejía, Herman Soto-Molina, Maritza Ramos-Ramírez, Diana Flores-Estrada, la de
BMC Cancer
Supportive care needs and quality of care of patients with lung cancer in Mexico: A cross-sectional study
Svetlana Doubova, Ricardo Pérez-Cuevas
European Journal of Oncology Nursing