Total Direct Costs of Ovarian Cancer in Colombia: A National Cohort Study Based on Administrative Claims Databases

OBJECTIVES: Ovarian cancer (OC) poses a high economic burden on healthcare systems worldwide; however, data regarding costs in low- and middle-income countries are scarce. This study aims to describe healthcare costs borne by the health system and incurred by patients with OC affiliated with the contributory regime in Colombia.

METHODS: A retrospective cohort of incident patients, with a first recorded OC diagnosis (index) from 1 January 2014–31 December 2015, was identified from patient-level data in national administrative claims databases. All healthcare costs incurred by patients were observed from the index date to either death or 31 December 2019. To adjust for differences in survival and duration of follow-up, we used Kaplan-Meier sample-average estimators with monthly intervals. All costs are annual and shown using survival-adjusted medians with interquartile ranges (IQR) and are expressed in 2019 international dollars. To identify characteristics associated with higher costs of care, we used generalized linear models, with a squared-root link function and a Poisson distribution.

RESULTS: We identified 1,047 patients with OC (mean age [standard deviation] 56.7 [13.5] years). Median costs of healthcare services were $17,652 per patient (IQR $17,434 to $17,849), ranging from $9,396 (IQR $8,889 to $9,976) during the first year to $629 (IQR $593 to $665) during the fifth-year post-diagnosis (576 patients). Most costs were related to outpatient (68.6%) and inpatient (28.5%) services. Affiliation with some insurers, older age at diagnosis, a higher comorbidity burden, a longer follow-up duration, and a higher proportion of services paid under fee for services schemes were associated with increases in healthcare costs.

CONCLUSIONS: OC is associated with substantial healthcare costs in the population affiliated with the contributory regime in Colombia. Despite the health system providing a unique health benefit package, significant differences (p<0.01) in healthcare costs remain between insurers and types of incentives to providers.