Health system costs and days in hospital for colorectal cancer patients in New South Wales, Australia

David E Goldsbury; Eleonora Feletto; Marianne F Weber; Philip Haywood; Alison Pearce; Jie-Bin Lew; Joachim Worthington; Emily He; Julia Steinberg; Dianne L O'Connell; Karen Canfell

doi:10.1371/journal.pone.0260088

Health system costs and days in hospital for colorectal cancer patients in New South Wales, Australia

PLoS One. 2021 Nov 29;16(11):e0260088. doi: 10.1371/journal.pone.0260088. eCollection 2021.

Authors

David E Goldsbury^{1

2}, Eleonora Feletto¹, Marianne F Weber¹, Philip Haywood^{2

3}, Alison Pearce², Jie-Bin Lew¹, Joachim Worthington¹, Emily He^{1

4}, Julia Steinberg¹, Dianne L O'Connell^{1

5}, Karen Canfell^{1

6}

Affiliations

¹ The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia.
² School of Public Health, University of Sydney, Sydney, NSW, Australia.
³ Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia.
⁴ Gastroenterology and Liver Department, Concord Hospital, Sydney, NSW, Australia.
⁵ School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
⁶ Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.

Abstract

Introduction: Colorectal cancer (CRC) care costs the Australian healthcare system more than any other cancer. We estimated costs and days in hospital for CRC cases, stratified by site (colon/rectal cancer) and disease stage, to inform detailed analyses of CRC-related healthcare.

Methods: Incident CRC patients were identified using the Australian 45 and Up Study cohort linked with cancer registry records. We analysed linked hospital admission records, emergency department records, and reimbursement records for government-subsidised medical services and prescription medicines. Cases' health system costs (2020 Australian dollars) and hospital days were compared with those for cancer-free controls (matched by age, sex, geography, smoking) to estimate excess resources by phase of care, analysed by sociodemographic, health, and disease characteristics.

Results: 1200 colon and 546 rectal cancer cases were diagnosed 2006-2013, and followed up to June 2016. Eighty-nine percent of cases had surgery, chemotherapy or radiotherapy, and excess costs were predominantly for hospitalisations. Initial phase (12 months post-diagnosis) mean excess health system costs were $50,434 for colon and $60,877 for rectal cancer cases, with means of 16 and 18.5 excess hospital days, respectively. The annual continuing mean excess costs were $6,779 (colon) and $8,336 (rectal), with a mean of 2 excess hospital days each. Resources utilised (costs and days) in these phases increased with more advanced disease, comorbidities, and younger age. Mean excess costs in the year before death were $74,952 (colon) and $67,733 (rectal), with means of 34 and 30 excess hospital days, respectively-resources utilised were similar across all characteristics, apart from lower costs for cases aged ≥75 at diagnosis.

Conclusions: Health system costs and hospital utilisation for CRC care are greater for people with more advanced disease. These findings provide a benchmark, and will help inform future cost-effectiveness analyses of potential approaches to CRC screening and treatment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Benchmarking
Colorectal Neoplasms / economics*
Cost-Benefit Analysis / methods
Databases, Factual
Government
Government Programs
Health Facilities / economics
Health Facilities / trends
Hospital Records
Hospitalization / economics*
Hospitalization / trends
Hospitals / statistics & numerical data
Humans
Length of Stay / economics
Length of Stay / trends*
Medical Assistance / economics
New South Wales
Registries

Grants and funding

DEG, EF, MFW, PH, JS and KC are investigators on a study of cancer patient population projections, funded by the Australian Government Medical Research Future Fund (MRFF) – Preventive and Public Health Research Initiative – 2019 Targeted Health System and Community Organization Research Grant Opportunity (MRF1200535). No funder had a role in study design, analysis, decision to publish, or preparation of the manuscript. KC and JBL received grants from the National Health and Medical Research Council of Australia (APP1194679 and APP1194784, respectively) during the conduct of the study. KC is an investigator on an unrelated investigator-initiated trial of cytology and primary HPV screening in Australia (Compass), which is conducted and funded by the Victorian Cytology Service (VCS), a government-funded health promotion charity. The VCS has received equipment and a funding contribution for the Compass trial from Roche Molecular Systems and Ventana. However, neither the authors nor the authors’ organisations receive direct funding from industry for this trial or any other project.