{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T01:33:33Z","timestamp":1791941613097,"version":"4.3.4"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T00:00:00Z","timestamp":1748390400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T00:00:00Z","timestamp":1748390400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100019587","name":"Universitas Islam Indonesia","doi-asserted-by":"publisher","award":["628\/Rek\/40\/DSDM\/II\/2020"],"award-info":[{"award-number":["628\/Rek\/40\/DSDM\/II\/2020"]}],"id":[{"id":"10.13039\/501100019587","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Groningen, University Medical Center Groningen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12913-025-12849-9","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T10:00:51Z","timestamp":1748426451000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Costs analysis of radiotherapy for breast cancer in Indonesia: a comparison between reimbursement tariffs and actual costs"],"prefix":"10.1186","volume":"25","author":[{"given":"Fithria Dyah Ayu","family":"Suryanegara","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deni","family":"Iskandar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ericko","family":"Ekaputra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eko","family":"Kuntjoro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didik","family":"Setiawan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten Jacobus","family":"Postma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa Aniek","family":"de Jong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,28]]},"reference":[{"key":"12849_CR1","unstructured":"BPJS Kesehatan. Penyakit katastropik berbiaya mahal tetap dijamin dalam program JKN-KIS 2021. Info BPJS Kesehatan Edisi 104. p.6-9."},{"key":"12849_CR2","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1159\/000502637","volume":"14","author":"D Trapani","year":"2019","unstructured":"Trapani D, Curigliano G, Eniu A. Breast cancer: reimbursement policies and adoption of new therapeutic agents by National health systems. Breast Care. 2019;14:373\u201381. https:\/\/doi.org\/10.1159\/000502637.","journal-title":"Breast Care"},{"key":"12849_CR3","unstructured":"GLOBOCAN. Estimated number of breast cancer new cases from 2022 to 2045: Indonesia. 2024. https:\/\/gco.iarc.fr\/tomorrow\/en\/dataviz\/tables?populations=360&cancers=20."},{"key":"12849_CR4","unstructured":"GLOBOCAN. Indonesia fact sheet 2022. 2024. https:\/\/gco.iarc.who.int\/media\/globocan\/factsheets\/populations\/360-indonesia-fact-sheet.pdf."},{"key":"12849_CR5","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1001\/jama.2018.19323","volume":"321","author":"AG Waks","year":"2019","unstructured":"Waks AG, Winer EP. Breast Cancer treatment: A review. JAMA - J Am Med Association. 2019;321:288\u2013300. https:\/\/doi.org\/10.1001\/jama.2018.19323.","journal-title":"JAMA - J Am Med Association"},{"key":"12849_CR6","unstructured":"Stebbing J, Delaney G, Thompson A. Breast cancer (non-metastatic). BMJ Clin Evid. 2011;02:1-43. https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC2943780\/."},{"key":"12849_CR7","doi-asserted-by":"publisher","first-page":"1707","DOI":"10.1016\/S0140","volume":"378","author":"Early Breast Cancer Trialists\u2019 Collaborative Group (EBCTCG)","year":"2011","unstructured":"Early Breast Cancer Trialists\u2019 Collaborative Group (EBCTCG). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378:1707\u201316. https:\/\/doi.org\/10.1016\/S0140.","journal-title":"Lancet"},{"key":"12849_CR8","doi-asserted-by":"crossref","unstructured":"Lievens Y, Defourny N, Corral J, Gasparotto C, Grau C, Borras M. How public health services pay for radiotherapy in Europe: an ESTRO-HERO analysis of reimbursement. Lancet Oncol. 2020;21:e42-e45. https:\/\/www.thelancet.com\/action\/showPdf?pii=S1470-2045%2819%2930794-6.","DOI":"10.1016\/S1470-2045(19)30794-6"},{"key":"12849_CR9","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/S0140-6736(18)31647-7","volume":"393","author":"R Agustina","year":"2019","unstructured":"Agustina R, Dartanto T, Sitompul R, Susiloretni KA, Suparmi, Achadi EL, et al. Universal health coverage in Indonesia: concept, progress, and challenges. 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Peraturan Menteri Kesehatan Republik Indonesia Nomor 64 Tahun 2016 tentang Perubahan atas Peraturan Menteri Kesehatan Nomor 52 Tahun 2016 tentang Standar Tarif Pelayanan Kesehatan dalam Penyelenggaraan Jaminan Kesehatan. 2016. https:\/\/peraturan.bpk.go.id\/Details\/114477\/permenkes-no-64-tahun-2016."},{"key":"12849_CR18","unstructured":"Ministry of Health Republic of Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 6 Tahun 2018 tentang Perubahan Ketiga atas Peraturan Menteri Kesehatan Nomor 52 Tahun 2016 tentang Standar Tarif Pelayanan Kesehatan dalam Penyelenggaraan Jaminan Kesehatan. 2018. https:\/\/peraturan.bpk.go.id\/Details\/139647\/permenkes-no-6-tahun-2018."},{"key":"12849_CR19","unstructured":"Ministry of Health Republic of Indonesia. 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Palliative radiotherapy practice within Western European countries: impact of the radiotherapy financing system? Radiother Oncol. 2000;56:289\u201395.","journal-title":"Radiother Oncol"},{"key":"12849_CR25","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.breast.2022.01.018","volume":"62","author":"GN Marta","year":"2022","unstructured":"Marta GN, Riera R, Pacheco RL, Cabrera Martimbianco AL, Meattini I, Kaidar-Person O, et al. Moderately hypofractionated post-operative radiation therapy for breast cancer: systematic review and meta-analysis of randomized clinical trials. Breast. 2022;62:84\u201392. https:\/\/doi.org\/10.1016\/j.breast.2022.01.018.","journal-title":"Breast"},{"key":"12849_CR26","doi-asserted-by":"publisher","first-page":"170","DOI":"10.3857\/roj.2020.00703","volume":"38","author":"SJ Huh","year":"2020","unstructured":"Huh SJ, Nishimura T, Park W, Onishi H, Ahn YC, Nakamura K. Current status and comparison of National health insurance systems for advanced radiation technologies in Korea and Japan. Radiat Oncol J. 2020;38:170\u20135. https:\/\/doi.org\/10.3857\/roj.2020.00703.","journal-title":"Radiat Oncol J"},{"key":"12849_CR27","doi-asserted-by":"crossref","unstructured":"Susilowati M, Afiyanti Y. The socio-demographic factors correlated with financial toxicity among patients with breast cancer in Indonesia. 10. 2021. https:\/\/journals.sagepub.com\/doi\/full\/10.4081\/jphr.2021.2403.","DOI":"10.4081\/jphr.2021.2403"},{"key":"12849_CR28","unstructured":"Borras JM, Lievens Y, Co- J, Corral A, Aggarwal R, Audisio C, et al. 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The Medical Health Research and Ethics Committee of the Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada reviewed and approved the study (approval numbers KE\/FK\/0449\/EC\/2018 and KE\/FK\/1413\/EC\/31 December 2021). According to the \u201cGuideline and Standard Ethics of Research and Development of National Health\u201d regulated by the Ministry of Health of the Republic of Indonesia, specifically outlined in point Q, obtaining informed consent for the use of secondary data is not necessary [].","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"In this current study, the consent for publication is not applicable, since we used claims data from the Department of Accounting of Public Hospital A and the Department of Finance of Private Hospital C. However, the authors maintain the anonymity, confidentiality, and privacy of data subjects by anonymizing the data before secondary use. The authors also keep the data secure and avoid harming the data subjects.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"766"}}