The economic burden of cancer care in Canada: a population-based cost study

Abstract

Background: Resource and cost issues are a growing concern in health care. Thus, it is important to have an accurate estimate of the economic burden of care. Previous work has estimated the economic burden of cancer care for Canada; however, there is some concern this estimate is too low. The objective of this analysis was to provide a comprehensive revised estimate of this burden.

Methods: We used a case-control prevalence-based approach to estimate direct annual cancer costs from 2005 to 2012. We used patient-level administrative health care data from Ontario to correctly attribute health care costs to cancer. We employed the net cost method (cost difference between patients with cancer and control subjects without cancer) to account for costs directly and indirectly related to cancer and its sequelae. Using average patient-level cost estimates from Ontario, we applied proportions from national health expenditures data to obtain the economic burden of cancer care for Canada. All costs were adjusted to 2015 Canadian dollars.

Results: Costs of cancer care rose steadily over our analysis period, from $2.9 billion in 2005 to $7.5 billion in 2012, mostly owing to the increase in costs of hospital-based care. Most expenditures for health care services increased over time, with chemotherapy and radiation therapy expenditures accounting for the largest increases over the study period. Our cost estimates were larger than those in the Economic Burden of Illness in Canada 2005-2008 report for every year except 2005 and 2006.

Interpretation: The economic burden of cancer care in Canada is substantial. Further research is needed to understand how the economic burden of cancer compares to that of other diseases.

Figure 1

Total (net) public expenditures (in constant 2015 dollars) on cancer care in Canada, 2005-2012, by cost category. Case subjects were matched to control subjects in 2005 and 2009. "Other care" includes nonphysician care (including other professional services performed outside the hospital setting), diagnostic testing, home care and assistive devices.

Figure 2

Total (net) public expenditures (in constant 2015 dollars) on radiation therapy and chemotherapy in Canada, 2005-2012. Case subjects were matched to control subjects in 2005 and 2009.

Figure 3

Total public expenditures (in constant 2015 dollars) on cancer care in Canada, 2008, by cost category. "Drugs" includes expenditures by both public and private insurance plans in the EBIC report estimates but includes only public expenditures in the current revised estimates. "Other care" includes home care, nonphysician care (including other professional services performed outside the hospital setting), diagnostic testing and assistive devices. Note: EBIC = Economic Burden of Illness in Canada 2005-2008.