OBJECTIVES: Breast cancer is the most prevalent cancer and a major financial burden to the health system in Indonesia. Radiotherapy plays an important role in preventing recurrence and mortality of breast cancer. The Indonesia Case Based Groups (INA-CBG) reimbursement tariff for radiotherapy has not changed since 2016. This study aimed to compare the tariff with the actual costs of radiotherapy in breast cancer patients based on real-world data from two Indonesian hospitals.

METHODS: We conducted a retrospective cohort study in a national public referral type A hospital in Yogyakarta Special Province and a private type C hospital in Central Java Province. We collected BPJS Kesehatan claims data from both hospitals of breast cancer (ICD-10 code C50.9) outpatients undergoing radiotherapy (INA-CBG code C-3-10-0) from 2017-2022. We analyzed the total actual costs, the actual cost per patient and visit, and the absolute and relative differences between the actual costs and INA-CBG tariff.

RESULTS: A total of 3,890 breast cancer patients were included in the study, with 74.4% from Public Hospital A. The total actual costs for radiotherapy in breast cancer outpatients were US$ 6,490,920 in Public Hospital A and US$ 1,787,200 in Private Hospital C. The total actual costs were significantly higher than the INA-CBG tariff, with a discrepancy of US$853,340 for Public Hospital A from 2017-2022 and US$ 727,370 for Private Hospital C from 2019-2022. The reimbursement for radiotherapy covered only approximately 80% of costs per visit and per patient in both hospitals.

CONCLUSIONS: The INA-CBG tariff for outpatient radiotherapy services for breast cancer was not sufficient to cover all of the actual costs in either Public Hospital A or Private Hospital C. There is a need to increase the tariff to cover the actual costs in Indonesian hospitals to assure the accessibility and availability of radiotherapy for breast cancer patients.