Bates Nicole, Callander Emily, Lindsay Daniel, Watt Kerrianne
College of Public Health, Medical and Veterinary Sciences (CPHMVS), James Cook University, Townsville, Australia.
Australian Institute of Tropical Health and Medicine (AITHM), James Cook University, Townsville, QLD, Australia.
Health Econ Rev. 2018 Oct 31;8(1):28. doi: 10.1186/s13561-018-0212-8.
Although cancer survival in general has improved in Australia over the past 30 years, Indigenous Australians, socioeconomically disadvantaged persons, and people living in remote areas still experience poorer health outcomes. This paper aims to describe the development of CancerCostMod, and to present the healthcare expenditure and patient co-payments for the first 12-months post-diagnosis. The base population is a census of all cancer diagnoses (excluding non-melanoma skin cancer) in Queensland, Australia between 1 July 2011 and 30 June 2012 (N = 25,553). Each individual record was linked to their Queensland Health Admitted Patient Data Collection, Emergency Department Information System, Medicare Benefits Schedule, and Pharmaceutical Benefits Scheme records from 1 July 2011 to 30 June 2015. Indigenous status was recorded for 87% of participants in our base population. Multiple imputation was used to assign Indigenous status to records where Indigenous status was missing. This base population was then weighted, using a programmed SAS macro (GREGWT) to be representative of the Australian population. We adopted a national healthcare perspective to estimate the cost of cancer for hospital episodes, ED presentations, primary healthcare, and prescription pharmaceuticals. We also adopted an individual perspective, to estimate the primary healthcare and prescription pharmaceutical patient co-payments. Once weighted, our sample represents approximately 123,900 Australians (1.7% Indigenous Australians). The total healthcare system cost of all cancers during the first 12-months post diagnosis was $4.8 billion, [corrected] and patient co-payments costs were $127 million. After adjusting for sex, age at diagnosis, Indigenous status, rurality, socioeconomic status, and broad cancer type, significant differences in costs were observed for population groups of interest within the first year post-diagnosis. This paper provides a more recent national estimate of the cost of cancer, and addresses current research gaps by highlighting the distribution of healthcare and individual costs by Indigenous status, rurality, and socioeconomic status.
尽管在过去30年里澳大利亚总体癌症生存率有所提高，但澳大利亚原住民、社会经济弱势群体以及生活在偏远地区的人们的健康状况仍然较差。本文旨在描述癌症成本模型（CancerCostMod）的开发过程，并呈现诊断后前12个月的医疗保健支出和患者自付费用。基础人群是2011年7月1日至2012年6月30日期间澳大利亚昆士兰州所有癌症诊断病例（不包括非黑色素瘤皮肤癌）的普查数据（N = 25,553）。每条个体记录都与他们2011年7月1日至2015年6月30日期间的昆士兰卫生部门住院患者数据收集、急诊科信息系统、医疗保险福利计划和药品福利计划记录相关联。基础人群中87%的参与者记录了原住民身份。对于缺失原住民身份记录的情况，采用多重填补法来赋予其原住民身份。然后使用一个SAS宏程序（GREGWT）对该基础人群进行加权，使其具有澳大利亚人口的代表性。我们从国家医疗保健角度估算了医院诊疗、急诊科就诊、初级医疗保健和处方药的癌症成本。我们还从个体角度估算了初级医疗保健和处方药的患者自付费用。加权后，我们的样本代表了约123,900名澳大利亚人（其中1.7%为澳大利亚原住民）。诊断后前12个月所有癌症的医疗保健系统总成本为48亿澳元（已修正），患者自付费用为1.27亿澳元。在对性别、诊断时年龄、原住民身份、农村地区状况、社会经济地位和广泛癌症类型进行调整后，观察到诊断后第一年感兴趣的人群组在成本上存在显著差异。本文提供了关于癌症成本的最新全国性估算，并通过突出按原住民身份、农村地区状况和社会经济地位划分的医疗保健和个人成本分布，解决了当前的研究空白。
