Costs of Cancer Care Across the Disease Continuum: An Analysis From a Health Payer Perspective in Brazil

OBJECTIVES: This analysis aims to estimate health plan payments for cancer care during the initial, continuing, and end-of-life phases of care for 10 malignancies and to examine variation in expenditures according to patient characteristics and the type of cancer.

METHODS: Retrospective non-interventional study using population-based health administrative database to identify 35–99 years patients diagnosed with one of the following cancers: breast, prostate, colon, rectum, lung, myeloma, ovary, bladder, pancreas, or stomach, from 2019 through 2022. We attributed payments for each patient to a phase of care, based on time from diagnosis until death or end of study interval: the initial phase (first 12 months post-diagnosis), the continuing phase (period between initial and end-of-life) and the end-of-life (the last 12 months of life). We summed payments for all claims attributable to the primary cancer diagnosis and analyzed the overall and phase-based costs and then by differing cancer type and year of diagnosis. All analyses were performed using statistical software with 5% significance level.

RESULTS: 543 patients diagnosed with one of the studied malignancies. Annual payments were generally highest during the end-of-life. Per-patient annualized average costs were highest in the last year of life, followed by the initial and continuing phases (medical services: US$39,645, US$10,115, US$6,793 and prescription drugs: US$26,208, US$22,581, and US$17,685, respectively). There was considerable variation in costs cancer by site. Annualized average costs varied by stage in all phases of care. Stages III and IV posed the greatest annual cost burden for all cancer type. Overall payments increased significantly across year, especially, the end-of-life phase.

CONCLUSIONS: Considerable differences exist in expenditures across phases of cancer care. By understanding the drivers of such payment variations across patient and tumor characteristics, we can inform efforts to decrease payments and increase quality, thereby reducing the burden of cancer care.