Economic burden of cancer: a population-based cost analysis

Abstract

Background: Cancer poses a substantial economic burden on health care systems.” Cost-of-illness” analysis allows for a comprehensive estimation of the costs of cancer care and for the identification of relative costs of specific subgroups of diseases, informing future decisions for governmental budgets allocation. Methods: We ran a population-based cost analysis in the Forlì-Cesena province (396.696 inhabitants) in 2016, using a government perspective (direct health care resources only). We considered 6 subgroups of cancers, using the International Classification of Diseases, 10th rev.: hematologic, gastrointestinal, breast, urogynecological, thoracic, rare tumours and others. We included five categories of services: inpatient, outpatient, emergency, and end-of-life care, drugs. We used National and Regional official charges for the valuation of care settings. For drugs, we used the national pharmaceutical formulary by AIFA. We estimated per capita (PC) cost by dividing the total cost for cancer subgroup for the total number of residents in the Forlì-Cesena Province. Results: Total costs equaled to more than 98 million euro. Among cancers subgroups, hematology absorbed the largest share (28%, 70,6 €PC costs), followed by gastrointestinal (20%, €49,6 PC costs). Thoracic accounted for 12% of total costs, but per patient costs were the highest (€19.349). Lowest per patient costs were in breast. Cost absorption is uneven referring to health care services, too: eg. gastrointestinal cancer absorbs about 30% of total inpatient care cost compare to only 8% for breast, which however accounts for 30% of total outpatient care whereas thoracic only 8%.Table: T7ALLHematologyBreastGastrointestUro-GynThoracicRare, OthersPatients (n°)11.9314.3882.7591.8491.457600877Inpat. Care*34.1078.3412.72110.1425.6043.9013.395Drugs*26.86410.6245.4962.4443.2382.7532.308Outpat. Care*17.8893.9555.3812.6232.5781.6721.677End-of-life care*18.7224.8021.7074.3282.4073.2202.257EmerG. Care*76428698153916964Total (€)*98.34828.01015.40419.69213.92011.6179.702Resident Popul. 396.696Per Capita Costs€247,9€70,6€38,8€49,6€35,1€29,3€24,5%100%28%16%20%14%12%10%PER PATIENT COSTS€8.243€6.383€5.583€10.650€9.553€19.349€11.067(*costs in thousands of €) Open table in a new tab (*costs in thousands of €) Conclusions: Our analysis sets the basis for better understanding total costs in cancer care and resource allocation among cancer subgroups and care settings. Benchmarking is feasible for the use of administrative databases.