Socioeconomic and Geographic Inequalities in Colorectal Cancer Care Utilization and Expenditures: A Decomposition Analysis
Author(s)
Bedasa Taye Merga, MPH1, Nikki Mccaffrey, PhD2, Suzanne. Robinson, PhD3, Mohammedreza Mohebbi, PhD1, Anita Lal, BEc, MPH, PhD3.
1Deakin University, Melbourne, Victoria, Australia, Australia, 2Deakin University, Melbourne, Australia, 3Deakin Health Economics, Deakin University, Melbourne, Victoria, Australia.
1Deakin University, Melbourne, Victoria, Australia, Australia, 2Deakin University, Melbourne, Australia, 3Deakin Health Economics, Deakin University, Melbourne, Victoria, Australia.
OBJECTIVES: To assess the extent and drivers of inequalities in total healthcare expenditures, out-of-pocket (OOP) costs, and government-subsidised benefits among CRC patients in Victoria, Australia.
METHODS: A population-based study was conducted using linked administrative data, including the Victorian Cancer Registry, Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS), hospital admissions, and emergency department (ED) records. Median regressions and two-part modelling (logistic regressions and generalised linear models) were used to identify determinants of healthcare utilisation and expenditures. Inequality was assessed using concentration indices (CI), and contributing factors were explored using Wagstaff decomposition analysis.
RESULTS: Of 11,258 CRC patients diagnosed in 2016-2018, 10,626 (94%) had at least one service claim. Healthcare utilizations and expenditures showed variations by socioeconomic status and geographic remoteness after being adjusted for gender, age, cancer site, birth country and stage at diagnosis. The OOP costs (CI = 0.202), PBS (CI=0.019) and MBS benefits (CI = 0.080) were pro-rich, whereas total cost (CI = -0.087), hospital and emergency department costs were pro-poor (hospital CI = -0.134; ED CI = -0.116). Patients from major cities had incurred higher OOP expenses and received more PBS and MBS benefits, while regional and remote patients faced higher hospital-related costs. The decomposition analysis identified socioeconomic status as the major contributor to inequality, followed by geographic remoteness, with smaller contributions from gender, cancer site, age, stage at diagnosis, and birth country.
CONCLUSIONS: Colorectal cancer care in Victoria shows clear socioeconomic and geographic inequalities. Socioeconomically disadvantaged and regional and remote patients face higher total costs, mainly driven by hospital-related costs, while socioeconomically advantaged and urban groups receive more subsidised care but incur greater out-of-pocket expenses. Equity-oriented actions—improving access to early diagnosis and treatment, reducing avoidable admissions, and easing costs for high-need patients are required to close these gaps.
METHODS: A population-based study was conducted using linked administrative data, including the Victorian Cancer Registry, Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS), hospital admissions, and emergency department (ED) records. Median regressions and two-part modelling (logistic regressions and generalised linear models) were used to identify determinants of healthcare utilisation and expenditures. Inequality was assessed using concentration indices (CI), and contributing factors were explored using Wagstaff decomposition analysis.
RESULTS: Of 11,258 CRC patients diagnosed in 2016-2018, 10,626 (94%) had at least one service claim. Healthcare utilizations and expenditures showed variations by socioeconomic status and geographic remoteness after being adjusted for gender, age, cancer site, birth country and stage at diagnosis. The OOP costs (CI = 0.202), PBS (CI=0.019) and MBS benefits (CI = 0.080) were pro-rich, whereas total cost (CI = -0.087), hospital and emergency department costs were pro-poor (hospital CI = -0.134; ED CI = -0.116). Patients from major cities had incurred higher OOP expenses and received more PBS and MBS benefits, while regional and remote patients faced higher hospital-related costs. The decomposition analysis identified socioeconomic status as the major contributor to inequality, followed by geographic remoteness, with smaller contributions from gender, cancer site, age, stage at diagnosis, and birth country.
CONCLUSIONS: Colorectal cancer care in Victoria shows clear socioeconomic and geographic inequalities. Socioeconomically disadvantaged and regional and remote patients face higher total costs, mainly driven by hospital-related costs, while socioeconomically advantaged and urban groups receive more subsidised care but incur greater out-of-pocket expenses. Equity-oriented actions—improving access to early diagnosis and treatment, reducing avoidable admissions, and easing costs for high-need patients are required to close these gaps.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE665
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Gastrointestinal Disorders, No Additional Disease & Conditions/Specialized Treatment Areas, Oncology