OBJECTIVES : Measure cancer-related direct expenditures and its determinants, from the third-party payer perspective, for patients newly diagnosed and treated by the Brazilian public health system (SUS) from 2000 to 2010.

METHODS : We used data from national administrative registries of all patients treated by the SUS. We restricted our sample to patients newly diagnosed between the years 2000 and 2010 with the most prevalent cancers in Brazil (breast, cervix, prostate, lung, colorectal and stomach). All expenditures related to chemotherapy and radiotherapy (including consultations and drugs) and cancer-related in-patient care (including all costs, namely fees, surgeries, exams, lab tests, consultations and drugs). The fees are defined by national norms. A generalized linear model with a gamma distribution was used to estimate the determinants of healthcare expenditures. Regressions were performed for the whole sample and then separately by cancer type.

RESULTS : A total 963,395 patients were diagnosed with cancer between 2000 and 2010: 37.6% breast, 19.7% cervix, 18.1% prostate, 8.6% colorectal, 11.2% lung, and 4.8% stomach cancer. Average monthly expenditures were 1,649.2$ and the average follow-up of 23 months. The average expenditure per patient who underwent chemotherapy was 12,869.5$ (780,395 patients), radiotherapy 4,146.7$ (485,192 patients) and oncologic surgery was 4,400.0$ (197,927 patients). The highest average monthly expenditure was observed for lung cancer (2,531$) followed by stomach cancer (2,242$). High discrepancies were observed between states, from 1,373$ (Amapá) to 2,463$ (Acre). All covariates were significantly related to expenditures. Monthly expenditures decreased with follow-up time and increased with death. Expenditures were lower among women and decreased continuously with patient’s age, with the lowest expenditures observed among patients older than 80. Covariates behaved similarly across cancer types,

CONCLUSIONS : Contrary to death and severity of disease at diagnosis, aging is not a major driver of healthcare expenditures. Strong asymmetries between states raise serious concerns about equity and quality.