A/Prof Louisa Gordon (QIMR Berghofer Medical Research Institute), Dr Daniel Lindsay (QIMR Berghofer Medical Research Institute), Dr Nikki McCaffrey (Deakin University), Dr Alison Pearce (The Daffodil Centre Sydney University), and Dr Katharina Merollini (University of Sunshine Coast)
Each year 150,000 Australians are told they have cancer, leaving them fearful and shocked. Fortunately, medical advances and improved treatment effectiveness 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. One therapy recently approved in Australia, a CAR T-cell therapy for a blood cancer, costs over $500,000 per patient.
There are now over 1.1 million people living with cancer in Australia, with 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. Members of the Australian Health Economic Society last month shared findings of high-quality population and patient-level data from clinical trials and large linked datasets.
Varying costs for different cancers
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 cost 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 (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 may lead to rapid diagnosis, access to targeted treatments, and potentially replace extensive diagnostic testing.
Palliative care
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 (August 2015 – June 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 three months (prior to pain screening) was $6,742 with costs higher for men ($7,924) than women ($5,367).
Aboriginal and Torres Strait Islander Peoples’ health
In another large, linked Queensland dataset, Lindsay and colleagues quantified Medicare service use and patient out-of-pocket costs of Aboriginal and Torres Strait Islander 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.
Productivity costs
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.
Why is cancer economics research crucial?
Collectively, this cancer economics research is designed to inform Australia’s policy makers of the economic burden incurred by 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 National Health and Medical Research Council, the Australian National Breast Cancer Foundation and Targeted Approaches To Improve Cancer Services for Aboriginal and Torres Strait Islander Australians (TACTICS).
Follow the authors on Twitter: @louisagord, @danblindsay, @nikki_mccaffrey, @aliepea, and @merollini.