Phase-specific Net Costs of Cancer Care in Ontario. Claire de Oliveira, M.A. PhD

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1 Phase-specific Net Costs of Cancer Care in Ontario Claire de Oliveira, M.A. PhD

2 Background Cancer: leading cause of death in Canada with costly implications for government and patients Cost estimates of cancer care are useful to inform/help formulate national cancer programs/policies and decisions around resource allocation Important input for economic evaluations Objective Estimate phase-specific net costs of care for the 21 most prevalent cancers, and remaining tumour sites combined, from the perspective of the Ontario MOHLTC

3 Methods Period of analysis: diagnosis between Cohort Selection: Ontario Cancer Registry Included: > 18 years of age assigned a single, valid ICD-O topography code corresponding to primary cancer diagnosis no second cancer diagnosed within 90 days of initial cancer diagnosis survived >30 days after initial diagnosis Excluded: missing, unusual or incorrect histology codes

4 Final sample: N = 402,399 patients Patients classified into one of following 21 cancers (22nd category - all other tumour sites combined): brain head and neck ovary female breast leukemia pancreas cervix liver prostate colorectal lung renal corpus uteri lymphoma testis esophagus melanoma thyroid gastric multiple myeloma urinary bladder

5 Databases and Resources: Patients linked to admin health care databases at ICES, chemo & radiation therapy data from CCO

6 Estimation of net costs by phase of care Net costs = difference in cost for cancer patients and noncancer control subjects Matching: Hard match: age, sex, index date (pseudo-dx date, death date) Propensity score match (caliper width 0.2 SDs): age, sex, income quintile; residence in LTC facility; rurality; LHIN Phase of care approach: assigns observation time and respective costs into distinct clinical phases Typically cancer curves have U-shape 3 phases

7 Source: Brown et al, Medical Care 2002

8 Estimation of net costs by phase of care Phases: Pre-diagnosis phase of care (3 months prediagnosis) Initial phase of care (6 months post-diagnosis) Terminal phase of care (12 months pre-death) Continuing phase of care (all time in between; expressed as annual value) Definition of phase length based on data, other studies and clinical judgment Cost estimates: 2009 dollars

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13 Summary of results Net costs of care highest in the initial and terminal phases Pre-diagnosis phase - Highest: multiple myeloma, renal, lymphoma - Lowest: melanoma - Issues: negative values for esophagus, gastric, pancreas, lung nonsensical Initial phase - Highest: esophagus, pancreas, brain, gastric - Lowest: melanoma, thyroid, prostate - Issues: none

14 Summary of results Net costs of care highest in the initial and terminal phases Continuing phase - Highest: multiple myeloma, leukemia, brain, liver - Lowest: melanoma - Issues: low values for esophagus and pancreas for males unexpected Terminal phase - Highest: brain, testis, leukemia, multiple myeloma - Lowest: melanoma - Issues: high value for testis few, old patients with high costs; large confidence intervals

15 Results Comparison with the US net costs (patients 65) - Costs highest for terminal phase, then initial phase - Initial phase : costs also highest for brain and pancreatic cancers, lowest for melanoma - Authors did not examine multiple myeloma - Continuing phase : costs also highest for liver and brain, lowest for melanoma, cervical and uterine cancer s - Terminal phase : costs also highest for brain and leukemia, lowest for melanoma - Authors did not examine testis and myeloma - Hospitalizations also account for the bulk of total cost of cancer care

16 Conclusions Costs attributable to cancer care in Ontario are substantial and vary by tumour site and phase of care generally highest for multiple myeloma and brain generally lowest for melanoma Inpatient hospitalizations comprise largest portion of cost of care for all cancers Results largely in agreement with previous research for Medicare patients in the US Concern: pre-diagnosis net costs do not seem right new matching algorithm may slightly change results; sometimes we don t observe U- shape

17 Policy implications Estimates useful for planning future cancer care budgets and setting priorities for resource allocation Improve quality of future cancer-related economic evaluations value to researchers and decision makers Next Steps Try new matching algorithm Continue BC-ON costing harmonization Aggregate 5-year net costs of care Lifetime costs of care

18 Authors: Claire de Oliveira, CAMH Reka Pataky BCCA Karen Bremner, UHN Jagadish Rangrej, ICES Kelvin Chan, Sunnybrook HSC Winson Cheung, BCCA Jeffrey Hoch, CCO/St. Michael s Hospital Stuart Peacock, BCCA Murray Krahn, UHN/THETA

19 Thank you. Acknowledgments: This study was funded by a project grant from the Canadian Cancer Society Research Institute (grant #20200) and the Canadian Centre for Applied Research in Cancer Control (ARCC). Contact information: Claire de Oliveira, M.A., PhD claire.deoliveira@camh.ca