Objective To analyze the distribution characteristics, structural changes, and influencing factors of hospitalization costs in breast cancer patients in a public Grade-A tertiary general hospital in Guangxi from 2019 to 2023. Methods The medical record front sheet data of breast cancer patients discharged from the hospital from January 1st, 2019 to December 31st, 2023 were collected. Descriptive statistics were used to analyze patients' basic characteristics, the hospitalization cost range distribution characteristics and its changing trend of. Grey correlation degree analysis and structural variation degree analysis were adopted to explore the composition and changes of medical costs. Univariate analysis and multivariate linear regression analysis were used to identify the influencing factors of hospitalization costs. Results A total of 15 893 breast cancer patients were enrolled. The average total hospitalization cost was 12 369.65 yuan, and the median total hospitalization cost was 7 587.71 yuan; 90.94% of patients had total hospitalization costs within 30 000 yuan. From 2019 to 2023, the average total hospitalization cost presented a trend of initial decline, subsequent rise, and then another fall: it decreased from 12 671.29 yuan in 2019 to 11 527.33 yuan in 2020, rose to a peak of 12 978.09 yuan in 2022, and dropped again to 12 601.23 yuan in 2023. The average costs per patient for medications, examinations, laboratory tests, and surgery were the main components of the average total hospitalization costs. Among them, average drug cost accounted for the highest proportion, which decreased from 51.95% in 2019 to 43.68% in 2023. Grey correlation degree analysis showed that the cost category with the highest consistency in the changing trend of total average hospitalization cost was average drug cost (correlation degree=0.965), followed by average other costs (0.805), average examination cost (0.717), average laboratory test cost (0.706), average surgical cost (0.686), average bed cost (0.675), average nursing cost (0.674), and average diagnosis and treatment cost (0.671). Structural variation degree analysis indicated that the overall structural variation degree of average total hospitalization costs from 2019 to 2023 was 17.05%, with the largest structural variation degree of 12.93% occurring during 2019-2020; in terms of structural variation contribution rate, the main cost categories causing the structural change of average total hospitalization costs were average drug cost (48.50%), average examination cost (22.46%), average laboratory test cost (18.30%), and average surgical cost (4.57%), with a cumulative contribution rate of 93.83%. Univariate analysis showed that there were statistically significant differences in total hospitalization costs among breast cancer patients with different ages, marital status, ethnicity, residence, discharge year, surgical treatment status, radiotherapy status, length of hospital stay, complications/comorbidities, readmission plan within 31 days after discharge, discharge outcome, and payment method (all P<0.05). Multivariate linear regression analysis revealed that the above variables (except for residence) were independent influencing factors of total hospitalization costs (all P<0.05), and the major influential factors included surgical treatment (β=0.319), length of hospital stay (β=0.135-0.287), and radiotherapy (β=0.192).Conclusion From 2019 to 2023, the average total hospitalization cost of breast cancer patients in this public Grade-A tertiary general hospital in Guangxi showed a trend of falling first, then rising, and falling again. The average drug cost was the core driving factor, and the diagnosis-related groups payment model played a positive role in optimizing the structure of hospitalization costs. Hospitalization costs of breast cancer patients were affected by multiple factors, among which surgical treatment status, length of hospital stay, and radiotherapy status are the main independent influencing factors.

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