Abstract
BackgroundGlobally, the number of cancer survivors has exceeded 32 million, with over one million of these in Australia. A trend of increasing cancer incidence, medical innovations and extended survival places growing pressure on healthcare systems around the world. One in two Australians will be diagnosed with cancer during their lifetime with expected overall 5-year survival for invasive cancers now at 68%. More than 50% of cancer survivors suffer late effects, such as physical (pulmonary, cognitive and cardiac effects, subsequent malignant neoplasms) and psychosocial effects (depression, anxiety and fear of recurrence) that are likely to require ongoing healthcare, but the economic burden of survivorship care is unclear. To our knowledge, no other Australian study has estimated long-term healthcare costs of cancer patients on a population level. The aim of this research is to quantify direct costs of long-term health service use from the date of diagnosis.
Methods
We retrospectively linked six routinely collected, administrative healthcare databases to capture the whole journey of health service contact (Queensland Cancer Register, Medicare Benefits Schedule, Pharmaceutical Benefit Schedule, Queensland Hospital Admitted Patient Data Collection, Emergency Department Information System, National Hospital Cost Data Collection). All residents of the state of Queensland, Australia, diagnosed with a first primary malignancy from 1997–2015 formed the cohort. State and national healthcare databases were linked with state-based Cancer Registry records to capture all health service use and healthcare costs for up to 20 years (or death, if this occurs first), starting from the date of cancer diagnosis until December 2016 where available. Overall costs are defined as the product from each individual cost component, consisting of pharmaceuticals, medical & allied health services, hospital admissions, emergency presentations and healthcare purchasing data. We used a bottom-up costing approach which allows for total cost calculations per patient and subgroup.
Results
Preliminary analyses show that a total of 368,426 people were diagnosed with a first primary malignancy during the study time frame. Mean age at diagnosis was 60.6 years (SD 15.4). The most common types of cancer across all diagnosis years were prostate (14.8%), melanoma (14.1%), breast (12.7%), colorectal (12.2%) and lung cancers (8.6%). Cancer diagnoses increased steadily over time from 4.1% in 1997 to 6.5% in 2015. The overall health service use and distribution of associated costs for this study cohort was detailed by type of cancer, cost components, time since diagnosis, age and gender.
Conclusion
This project improves the understanding of lifetime health effects faced by cancer survivors and estimates ongoing healthcare costs. Results inform economic evaluations and policy and facilitate future planning for the allocation of healthcare resources according to the burden of disease.