Building evidence on the healthcare costs of cancer to keep track of the value in health

Prepared by the new AHES Cancer Economics Special Interest Group. For more information, please contact the AHES Cancer Economics Special Interest Group (email: Louisa.Gordon@qimrberghofer.edu.au)

Each year 150,000 Australians are told they have cancer by their doctor, evoking fear and shock in these individuals. Improvements in the effectiveness of treatments and medical advances have greatly improved survival prospects such that a cancer diagnosis is not the death sentence it once was. However, these same medical advances are also making the costs of cancer rise phenomenally fast with one therapy recently approved in Australia, a CAR T-cell therapy for one of the blood cancers, costing over $500,000 per patient. There are now over 1.1 million people living with cancer in Australia, most needing ongoing follow up medical care. Understanding the healthcare costs of cancer from detection and diagnosis through to survivorship and palliative care, is increasingly important for such a common and expensive disease.

The newly formed AHES Cancer Economics SIG has complied a summary of the most recent estimates from clinical trials and large linked datasets that members of the AHES Cancer Economics SIG are involved in.

Merollini and colleagues assessed the hospital, emergency, pharmaceutical and medical services costs from a cohort of over 230,000 Queenslanders with cancer. For all cancers combined, the average healthcare costs in the first year after diagnosis was $15,889 per person but was highest for myeloma $45,951, brain $30,264 and liver cancer $29,619.

Gordon and colleagues investigated the diagnostic work-up of a rare and difficult-to-diagnose cancer, cancer of unknown primary (or CUP). Pre-diagnosis costs for patients with CUP are triple those for ovarian cancer at $3,249 per person and continued to be high after diagnosis due to imaging, procedures and medicines. CUP needs to be diagnosed much earlier, and the use of molecular testing in future may lead to rapid diagnosis, access to targeted treatments and potentially replace extensive diagnostic testing.

McCaffrey and colleagues studied the treatment patterns and service use of patients with advanced cancer living with pain recruited from six Australian cancer palliative care outpatient services to the STOP Cancer Pain trial (Aug 2015-Jun 2019). To manage the pain and other symptoms, the most frequently prescribed drug types were opioids (60.1%), peptic ulcer/gastric reflux drugs (51.6%), anti-seizure drugs (26.6%) and corticosteroids (25.5%). The total average healthcare cost over 3 months (prior to pain screening) was $6,742 with costs being higher for men ($7,924) than for women ($5,367).

In another large, linked Queensland dataset, Lindsay and colleagues quantified Medicare service use and patient out-of-pocket costs of First Nations people and other Queenslanders with cancer. When controlling for other factors, they found First Nations people had significantly fewer out-of-pocket expenses for billed Medicare services and they were bulk-billed more often than others. However, First Nations people were not visiting specialists or receiving medical procedures as often as other Queenslanders.

When people stop working due to cancer, this represents a loss to society in the form of lost productivity. Pearce and colleagues assessed the economic losses to society due to cancer in Australia in 2016. There were 10,513 cancer deaths among working age adults, which led to over 118,780 years of productive life lost valued at over $4 billion in lost productivity. This rises to 40,282 deaths, 548,852 years of productive life lost and $14 billion in lost productivity when also considering unpaid work roles such as caring for relatives or children, volunteering, and household tasks.

Collectively, this cancer economics research is designed to inform policy makers of the economic burden incurred by Australians with cancer, helping to plan services and allocate resources. It is also critical for assessing the value-for-money of new cancer therapies and diagnostics and adds vital knowledge on the potential health system savings when making investments into cancer prevention.

These projects were supported by the NHMRC, the Australian National Breast Cancer Foundation and TACTICS CRE.

Callander, E., Bates, N., Lindsay, D., Larkins, S., Topp, S. M., Cunningham, J., ... & Garvey, G. (2019). Long-term out of pocket expenditure of people with cancer: Comparing health service cost and use for indigenous and non-indigenous people with cancer in Australia. International journal for equity in health, 18(1), 1-11.

Gordon, L. G., Wood, C., Tothill, R. W., Webb, P. M., Schofield, P., & Mileshkin, L. (2022). Healthcare Costs Before and After Diagnosis of Cancer of Unknown Primary Versus Ovarian Cancer in Australia. PharmacoEconomics-Open, 1-10.

Luckett, T., Phillips, J., Agar, M., Lam, L., Davidson, P. M., McCaffrey, N., ... & Lovell, M. (2018). Protocol for a phase III pragmatic stepped wedge cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of screening and guidelines with, versus without, implementation strategies for improving pain in adults with cancer attending outpatient oncology and palliative care services: the Stop Cancer PAIN trial. BMC health services research, 18(1), 1-13.

Merollini, K. M., Gordon, L. G., Ho, Y. M., Aitken, J. F., & Kimlin, M. G. (2022). Cancer Survivors’ Long-Term Health Service Costs in Queensland, Australia: Results of a Population-Level Data Linkage Study (Cos-Q). International journal of environmental research and public health, 19(15), 9473.

Pearce, A., Bradley, C., Hanly, P., O’Neill, C., Thomas, A. A., Molcho, M., & Sharp, L. (2016). Projecting productivity losses for cancer-related mortality 2011–2030. Bmc Cancer, 16(1), 1-10.