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Merollini KMD, Collins LG, Jones AT, Aitken JF, Kimlin MG. Factors impacting hospitalisation and related health service costs in cancer survivors in Australia: Results from a population data linkage study in Queensland (COS-Q). Cancer Med 2024; 13:e70201. [PMID: 39254066 PMCID: PMC11386302 DOI: 10.1002/cam4.70201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND The global economic cost of cancer and the costs of ongoing care for survivors are increasing. Little is known about factors affecting hospitalisations and related costs for the growing number of cancer survivors. Our aim was to identify associated factors of cancer survivors admitted to hospital in the public system and their costs from a health services perspective. METHODS A population-based, retrospective, data linkage study was conducted in Queensland (COS-Q), Australia, including individuals diagnosed with a first primary cancer who incurred healthcare costs between 2013 and 2016. Generalised linear models were fitted to explore associations between socio-demographic (age, sex, country of birth, marital status, occupation, geographic remoteness category and socio-economic index) and clinical (cancer type, year of/time since diagnosis, vital status and care type) factors with mean annual hospital costs and mean episode costs. RESULTS Of the cohort (N = 230,380) 48.5% (n = 111,820) incurred hospitalisations in the public system (n = 682,483 admissions). Hospital costs were highest for individuals who died during the costing period (cost ratio 'CR': 1.79, p < 0.001) or living in very remote or remote location (CR: 1.71 and CR: 1.36, p < 0.001) or aged 0-24 years (CR: 1.63, p < 0.001). Episode costs were highest for individuals in rehabilitation or palliative care (CR: 2.94 and CR: 2.34, p < 0.001), or very remote location (CR: 2.10, p < 0.001). Higher contributors to overall hospital costs were 'diseases and disorders of the digestive system' (AU$661 m, 21% of admissions) and 'neoplastic disorders' (AU$554 m, 20% of admissions). CONCLUSIONS We identified a range of factors associated with hospitalisation and higher hospital costs for cancer survivors, and our results clearly demonstrate very high public health costs of hospitalisation. There is a lack of obvious means to reduce these costs in the short or medium term which emphasises an increasing economic imperative to improving cancer prevention and investments in home- or community-based patient support services.
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Affiliation(s)
- Katharina M. D. Merollini
- School of HealthUniversity of the Sunshine CoastMaroochydoreQueenslandAustralia
- Sunshine Coast Health InstituteBirtinyaQueenslandAustralia
| | - Louisa G. Collins
- Health Economics, Population Health DepartmentQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
- School of NursingQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Andrew T. Jones
- Centre for Health Services Research, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Joanne F. Aitken
- Cancer Council QueenslandBrisbaneQueenslandAustralia
- School of Public HealthUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Michael G. Kimlin
- Faculty of Health Sciences & MedicineBond UniversityRobinaQueenslandAustralia
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Edney LC, Roseleur J, Bright T, Watson DI, Arnolda G, Braithwaite J, Delaney GP, Liauw W, Mitchell R, Karnon J. DAta Linkage to Enhance Cancer Care (DaLECC): Protocol of a Large Australian Data Linkage Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5987. [PMID: 37297591 PMCID: PMC10252629 DOI: 10.3390/ijerph20115987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
Cancer is a leading cause of global morbidity and mortality, accounting for 250 Disability-Adjusted Life Years and 10 million deaths in 2019. Minimising unwarranted variation and ensuring appropriate cost-effective treatment across primary and tertiary care to improve health outcomes is a key health priority. There are few studies that have used linked data to explore healthcare utilisation prior to diagnosis in addition to post-diagnosis patterns of care. This protocol outlines the aims of the DaLECC project and key methodological features of the linked dataset. The primary aim of this project is to explore predictors of variations in pre- and post-cancer diagnosis care, and to explore the economic and health impact of any variation. The cohort of patients includes all South Australian residents diagnosed with cancer between 2011 and 2020, who were recorded on the South Australian Cancer Registry. These cancer registry records are being linked with state and national healthcare databases to capture health service utilisation and costs for a minimum of one-year prior to diagnosis and to a maximum of 10 years post-diagnosis. Healthcare utilisation includes state databases for inpatient separations and emergency department presentations and national databases for Medicare services and pharmaceuticals. Our results will identify barriers to timely receipt of care, estimate the impact of variations in the use of health care, and provide evidence to support interventions to improve health outcomes to inform national and local decisions to enhance the access and uptake of health care services.
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Affiliation(s)
- Laura C. Edney
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Jackie Roseleur
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Tim Bright
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, SA 5042, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - David I. Watson
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, SA 5042, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Geoffrey P. Delaney
- Liverpool Cancer Therapy Centre, Liverpool, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Winston Liauw
- St. George Cancer Care Centre, St. George Hospital, Kogarah, NSW 2217, Australia
- St. George Hospital Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
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Merollini KMD, Gordon LG, Ho YM, Aitken JF, Kimlin MG. 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 2022; 19:ijerph19159473. [PMID: 35954835 PMCID: PMC9368477 DOI: 10.3390/ijerph19159473] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 12/04/2022]
Abstract
Worldwide, the number of cancer survivors is rapidly increasing. The aim of this study was to quantify long-term health service costs of cancer survivorship on a population level. The study cohort comprised residents of Queensland, Australia, diagnosed with a first primary malignancy between 1997 and 2015. Administrative databases were linked with cancer registry records to capture all health service utilization. Health service costs between 2013–2016 were analyzed using a bottom-up costing approach. The cumulative mean annual healthcare expenditure (2013–2016) for the cohort of N = 230,380 individuals was AU$3.66 billion. The highest costs were incurred by patients with a history of prostate (AU$538 m), breast (AU$496 m) or colorectal (AU$476 m) cancers. Costs by time since diagnosis were typically highest in the first year after diagnosis and decreased over time. Overall mean annual healthcare costs per person (2013–2016) were AU$15,889 (SD: AU$25,065) and highest costs per individual were for myeloma (AU$45,951), brain (AU$30,264) or liver cancer (AU$29,619) patients. Our results inform policy makers in Australia of the long-term health service costs of cancer survivors, provide data for economic evaluations and reinforce the benefits of investing in cancer prevention.
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Affiliation(s)
- Katharina M. D. Merollini
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD 4558, Australia
- Sunshine Coast Health Institute, Birtinya, QLD 4575, Australia
- Correspondence: ; Tel.: +61-7-5202-3159
| | - Louisa G. Gordon
- Health Economics, Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD 4006, Australia;
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia;
- School of Biomedical Sciences, Queensland University of Technology, St. Lucia, QLD 4072, Australia;
| | - Yiu M. Ho
- Rockhampton Hospital, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia;
- Rural Clinical School, The University of Queensland, Rockhampton, QLD 4700, Australia
| | - Joanne F. Aitken
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia;
- Cancer Council Queensland, Fortitude Valley, QLD 4006, Australia
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD 4006, Australia
| | - Michael G. Kimlin
- School of Biomedical Sciences, Queensland University of Technology, St. Lucia, QLD 4072, Australia;
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Gordon LG, Leung W, Johns R, McNoe B, Lindsay D, Merollini KMD, Elliott TM, Neale RE, Olsen CM, Pandeya N, Whiteman DC. Estimated Healthcare Costs of Melanoma and Keratinocyte Skin Cancers in Australia and Aotearoa New Zealand in 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3178. [PMID: 35328865 PMCID: PMC8948716 DOI: 10.3390/ijerph19063178] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/22/2022] [Accepted: 03/02/2022] [Indexed: 02/06/2023]
Abstract
Australia and Aotearoa New Zealand have the highest incidence of melanoma and KC in the world. We undertook a cost-of-illness analysis using Markov decision-analytic models separately for melanoma and keratinocyte skin cancer (KC) for each country. Using clinical pathways, the probabilities and unit costs of each health service and medicine for skin cancer management were applied. We estimated mean costs and 95% uncertainty intervals (95% UI) using Monte Carlo simulation. In Australia, the mean first-year costs of melanoma per patient ranged from AU$644 (95%UI: $642, $647) for melanoma in situ to AU$100,725 (95%UI: $84,288, $119,070) for unresectable stage III/IV disease. Australian-wide direct costs to the Government for newly diagnosed patients with melanoma were AU$397.9 m and AU$426.2 m for KCs, a total of AU$824.0 m. The mean costs per patient for melanoma ranged from NZ$1450 (95%UI: $1445, $1456) for melanoma in situ to NZ$77,828 (95%UI $62,525, $94,718) for unresectable stage III/IV disease. The estimated total cost to New Zealand in 2021 for new patients with melanoma was NZ$51.2 m, and for KCs, was NZ$129.4 m, with a total combined cost of NZ$180.5 m. These up-to-date national healthcare costs of melanoma and KC in Australia and New Zealand accentuate the savings potential of successful prevention strategies for skin cancer.
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Affiliation(s)
- Louisa G. Gordon
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.M.E.); (R.E.N.); (C.M.O.); (N.P.); (D.C.W.)
- Cancer and Palliative Care Outcomes Centre and School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia;
| | - William Leung
- Wellington School of Medicine, University of Otago, Wellington 6242, New Zealand;
| | - Richard Johns
- Kenmore Skin Clinic, Moggill Rd, Brisbane, QLD 4069, Australia;
| | - Bronwen McNoe
- Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin 9016, New Zealand;
| | - Daniel Lindsay
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia;
| | - Katharina M. D. Merollini
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD 4558, Australia;
- Sunshine Coast Health Institute, Birtinya, QLD 4575, Australia
| | - Thomas M. Elliott
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.M.E.); (R.E.N.); (C.M.O.); (N.P.); (D.C.W.)
| | - Rachel E. Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.M.E.); (R.E.N.); (C.M.O.); (N.P.); (D.C.W.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia;
| | - Catherine M. Olsen
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.M.E.); (R.E.N.); (C.M.O.); (N.P.); (D.C.W.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia;
| | - Nirmala Pandeya
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.M.E.); (R.E.N.); (C.M.O.); (N.P.); (D.C.W.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia;
| | - David C. Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.M.E.); (R.E.N.); (C.M.O.); (N.P.); (D.C.W.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia;
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McErlean G, Brice L, Gilroy N, Kabir M, Greenwood M, Larsen SR, Moore J, Gottlieb D, Hertzberg M, Brown L, Hogg M, Huang G, Ward C, Kerridge I. Long-term treatment burden following allogeneic blood and marrow transplantation in NSW, Australia: a cross-sectional survey. J Cancer Surviv 2021; 16:432-444. [PMID: 33813667 DOI: 10.1007/s11764-021-01038-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Allogenic blood and marrow transplant (allo-BMT) is an arduous treatment used increasingly for many life-threatening conditions. Recognition of the profound impacts of the long term and late effects is ever-growing, as is the healthcare workload (treatment burden) of survivorship. PURPOSE To quantify the treatment burden of long-term survival following allo-BMT, regarding the range of health services, therapies and investigations accessed by survivors. METHODS A large, multi-centre cross-sectional survey of adult allo-BMT survivors transplanted between 2000 and 2012 in Sydney, Australia. Participants completed six validated instruments and one purposed designed for the study, the Sydney Post BMT Study (SPBS), answering questions relating to medication use, medical treatments, referrals, assessments and frequency of hospital/clinic attendance. RESULTS Of the 441 allo-BMT survivors, over a quarter who were more than 2 years post BMT attended the hospital clinic at least monthly, and 26.7% required a number of regular medical procedures (e.g. venesection, extracorpororeal photopheresis). Specialist medical and allied health referral was very common, and compliance with internationally recommended long-term follow-up (LTFU) care was suboptimal and decreased as time from BMT increased. CONCLUSION Respondents reported a large medication (conventional and complementary), screening, assessment and health care burden. IMPLICATIONS FOR CANCER SURVIVORS Treatment burden contributes significantly to the 'workload' of survivorship and can have a severe and negative impact on BMT survivors, carers and the healthcare system-making it difficult to comply with optimal care. Clinicians must be primed with skills to identify survivors who are overburdened by the health care required for survival and develop strategies to help ease the burden.
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Affiliation(s)
- Gemma McErlean
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia. .,Cancer Services, South Western Sydney Local Health District, Sydney, NSW, Australia. .,Centre for Applied Nursing Research and Ingham Institute of Applied Medical Research, Sydney, NSW, Australia. .,Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia.
| | - Lisa Brice
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nicole Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Matt Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Stephen R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - John Moore
- Department of Haematology, St Vincents Hospital, Sydney, NSW, Australia
| | - David Gottlieb
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Louisa Brown
- Department of Haematology, Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Megan Hogg
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Gillian Huang
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Christopher Ward
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Ian Kerridge
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
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Australian Experiences of Out-of-Pocket Costs and Financial Burden Following a Cancer Diagnosis: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052422. [PMID: 33801282 PMCID: PMC7967550 DOI: 10.3390/ijerph18052422] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 02/05/2023]
Abstract
(1) Background: This systematic review was conducted to identify cancer patient experiences, and the impact of out-of-pocket costs and financial burden in Australia. (2) Methods: A systematic review, following the Preferring Reporting Items for Systematic Reviews and Meta-Analyses, was conducted. Cumulative Index of Nursing and Allied Health Literature and PubMed were searched. The primary outcome was financial burden among cancer patients and their families in Australia. The secondary outcome was out-of-pocket costs associated with cancer care and treatment within the population sample, and the impact of financial burden. (3) Results: Nineteen studies were included, covering more than 70,000 Australians affected by cancer. Out-of-pocket costs varied by cancer type and ranged from an average of AUD 977 for breast cancer and lymphoedema patients to AUD 11,077 for prostate cancer patients. Younger aged patients (≤65 years), Aboriginal and Torres Strait Islander people, people in rural and/or remote areas, households with low income, those who were unemployed and people with private health insurance were at increased risk of experiencing out-of-pocket costs, financial burden or a combination of both. (4) Conclusions: Australians diagnosed with cancer frequently experience financial burden, and the health and financial consequences are significant. Focusing efforts on the costs of care and options about where to have care within the context of informed decisions about cancer care is necessary.
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