This is the first nationwide study to explore whether the use of TCM reduces the medical cost of lung cancer inpatients in mainland China. Since most lung cancer patients are likely to succumb within 5 years of diagnosis (16), patients, their families and carers seek a wide range of treatments, including TCM (17, 18). Our data show that between 2010 to 2016 the proportion of TCM users gradually increased, outweighing TCM nonusers, perhaps related to the Chinese government’s emphasis on TCM, including preferential policies for TCM hospitals.
The total inpatient cost of TCM users was higher than those of TCM nonusers controlling for demographic characteristics. Our results showed that the total inpatient cost of lung cancer TCM users was 65.2% higher than that of TCM nonusers. This seems to be contrary to previous research that demonstrated complementary and alternative medicine was generally cheaper than conventional medication, and that the use of complementary and alternative medicine could reduce the economic burden of disease (19, 20). We found that the median cost of conventional medicine medication costs for TCM users was RMB7384 (USD1112), which is significantly higher than RMB3032 (USD456) for TCM nonusers. Similarly, the median nonpharmacy cost of TCM users was RMB7302 (USD1099), which was also significantly higher than that of TCM nonusers (RMB3363/USD506). The medication, conventional medicine medication and nonpharmacy costs of TCM users was all higher than TCM nonusers, which shows that higher medical cost of TCM users was not just do to TCM treatments. One possible explanation is that the disease status of TCM users was more serious than TCM nonusers, so all kinds of medical services were consumed more by TCM users than TCM nonusers. With confounding factors fixed, regression results show that TCM costs had a positive correlation with conventional medication cost as well as nonpharmacy cost, indicting synchronous increase of TCM cost, conventional medication cost, and nonpharmacy cost for TCM users. Our data show that the use of TCM did not reduce the use of conventional medicine. Given the large gap between the total cost of traditional Chinese medicine (10.2%) and the cost of conventional drugs (69.3%), TCM treatment mainly plays a complementary, not substitute, role.
There are several possible reasons why the TCM, conventional medicine medication, and nonpharmacy cost for TCM users increase simultaneously. First, TCM users also used conventional medicine treatments, so TCM users faced more treatments than TCM nonusers. Second, TCM users might have a more serious disease status than TCM nonusers, then they have to utilize more medical services, including both TCM services and conventional medical services. Clinical studies show that surgical resection of lesions and other lung cancer treatment methods cause significant body damage and a variety of side effects, such as liver and kidney damage, decreasing immunity, multiple infections, vomiting and diarrhea (6–8, 21, 22), so patients and doctors might use TCM to reduce the side effects of conventional medicine treatment (23, 24). Third, TCM higher costs might also be related to health providers’ profit-seeking behavior. Medical service providers were allowed to add a mark-up on all non-TCM drug sales, usually about 15%, which increased hospital and doctor income and encouraged over-prescribing, before the drug zero-markup policy came into effect in all hospital in 2017 (25). Finally, some patients may seek excessive treatments (26).
When both TCM and conventional medicine play an active role in clinical diagnosis and treatment, doctors need to consider when TCM treatments and conventional medicine treats complement or substitute for each other. In this case, using either conventional medicine or TCM treatments, but not both, would control treatment costs. Doctors need training on when TCM and conventional medicine can be substitutes, and patients also need to be informed about the choices between TCM and conventional medicine treatments. For the treatment of lung cancer, there are relatively clear clinical guidelines for the use of conventional drugs, but not TCM drug treatment (27, 28). Given that the Chinese government re-emphasized in 2021 that it "attached equal importance to TCM and Western medicine", we recommend a joint Clinical Guideline to codify the use of TCM and conventional medicine for lung cancer treatment. Such a codification would inform the treatment plan for patients, attaining an appropriate balance between TCM and conventional medicine treatments. According to patients’ actual needs, TCM and conventional medicine should reflect a reasonable substitution relationship, which can not only give full play to the therapeutic role of integrated TCM and conventional medicine but also control the economic medical burden on patients.
There are some limitations in the present study. First, the CHIRA database did not include efficacy indicators for clinical treatment and could not provide evidence on the actual efficacy and clinical outcomes. Second, TCM hospitals were the main body for TCM treatment service provision, but the CHIRA marker for hospital category did not include this information. Future research should collect information from TCM and non-TCM hospitals. The CHIRA database did not provide information on the stage of lung cancer, so we are unable to analyze the cost differences caused by different treatments for different lung cancer stages. Future research should collect data on the lung cancer stage. Third, acupuncture and massage are also important components of TCM treatment, but the cost information of both was recorded in the nonpharmacy costs and cannot be identified individually. Our study can only attribute acupuncture and massage to nonmedication therapy services. Finally, the coverage years of our data were from 2010 to 2016 due to the CHIRA limitations on post-2016 access. In China’s fragmented insurance system, UEBMI and URBMI were the two schemes for the urban population until an amalgamation of URBMI and New Rural Cooperative Medical Scheme (NCMS) beginning in 2017 but currently incomplete. Importantly, the amalgamation of NCMS with URBMI aimed to upgrade rural benefits and coverage to the same level as URBMI. As a result, the CHIRA data are consistent with current URBMI, as well as UEBMI, benefits and coverage.