Health services costs for cancer care in Australia: Estimates from the 45 and Up Study

Abstract

Background: Cancer care represents a substantial and rapidly rising healthcare cost in Australia. Our aim was to provide accurate population-based estimates of the health services cost of cancer care using large-scale linked patient-level data.

Methods: We analysed data for incident cancers diagnosed 2006-2010 and followed to 2014 among 266,793 eligible participants in the 45 and Up Study. Health system costs included Medicare and pharmaceutical claims, inpatient hospital episodes and emergency department presentations. Costs for cancer cases and matched cancer-free controls were compared, to estimate monthly/annual excess costs of cancer care by cancer type, before and after diagnosis and by phase of care (initial, continuing, terminal). Total costs incurred in 2013 were also estimated for all people diagnosed in Australia 2009-2013.

Results: 7624 participants diagnosed with cancer were matched with up to three controls. The mean excess cost of care per case was AUD$1,622 for the year before diagnosis, $33,944 for the first year post-diagnosis and $8,796 for the second year post-diagnosis, with considerable variation by cancer type. Mean annual cost after the initial treatment phase was $4,474/case and the mean cost for the last year of life was $49,733/case. In 2013 the cost for cancers among people in Australia diagnosed during 2009-2013 was ~$6.3billion (0.4% of Gross Domestic Product; $272 per capita), with the largest costs for colorectal cancer ($1.1billion), breast cancer ($0.8billion), lung cancer ($0.6billion) and prostate cancer ($0.5billion).

Conclusions: The cost of cancer care is substantial and varies by cancer type and time since diagnosis. These findings emphasise the economic importance of effective primary and secondary cancer prevention strategies.

Fig 1. Cohort selection flow diagram.

NMSC: Non-melanoma skin cancer; NSWCR: New South Wales Cancer Registry. Matching variables were age (±5 years), sex, Local Government Area of residence and smoking history (never or quit >15 years, recent quitter within 15 years, current smoker).

Fig 2. Distribution of cases included for analysis (diagnosed 2006–2010) by spread of disease at diagnosis and cancer type, compared with all cases in New South Wales (NSW) diagnosed 2008–2012.

Results not shown for Non-Hodgkin lymphoma or leukaemia, ~90% recorded as “Unknown” for both.