Health services costs for ovarian cancer in Australia: Estimates from the 45 and Up Study

David E Goldsbury; Amy Vassallo; Marianne F Weber; Julia Steinberg; Penelope M Webb; Anna DeFazio; Karen Canfell

doi:10.1371/journal.pone.0282851

Health services costs for ovarian cancer in Australia: Estimates from the 45 and Up Study

PLoS One. 2023 Apr 18;18(4):e0282851. doi: 10.1371/journal.pone.0282851. eCollection 2023.

Authors

David E Goldsbury¹, Amy Vassallo^{2

3

4}, Marianne F Weber¹, Julia Steinberg¹, Penelope M Webb⁵, Anna DeFazio^{1

6

7

8}, Karen Canfell^{1

7

9}

Affiliations

¹ The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia.
² The George Institute for Global Health, UNSW, Sydney, Australia.
³ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁴ Past Affiliation Cancer Research Division, Cancer Council NSW, Sydney, Australia.
⁵ Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia.
⁶ Department of Gynaecological Oncology, Westmead Hospital, Sydney, NSW.
⁷ Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁸ Centre for Cancer Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia.
⁹ Prince of Wales Clinical School, UNSW Medicine, Sydney, NSW, Australia.

Abstract

Introduction: There have been significant advancements in risk identification and treatment for ovarian cancer over the last decade. However, their impact on health services costs is unclear. This study estimated the direct health system costs (government perspective) for women diagnosed with ovarian cancer in Australia during 2006-2013, as a benchmark prior to opportunities for precision-medicine approaches to treatment, and for health care planning.

Methods: Using cancer registry data, we identified 176 incident ovarian cancers (including fallopian tube and primary peritoneal cancer) in the Australian 45 and Up Study cohort. Each case was matched with four cancer-free controls on sex, age, geography, and smoking history. Costs were derived from linked health records on hospitalisations, subsidised prescription medicines and medical services to 2016. Excess costs for cancer cases were estimated for different phases of care relative to cancer diagnosis. Overall costs for prevalent ovarian cancers in Australia in 2013 were estimated based on 5-year prevalence statistics.

Results: At diagnosis, 10% of women had localised disease, 15% regional spread and 70% distant metastasis (5% unknown). The mean excess cost per ovarian cancer case was $40,556 in the initial treatment phase (≤12 months post-diagnosis), $9,514 per annum in the continuing care phase and $49,208 in the terminal phase (up to 12 months before death). Hospital admissions accounted for the greatest proportion of costs during all phases (66%, 52% and 68% respectively). Excess costs were higher for patients diagnosed with distant metastatic disease, particularly during the continuing care phase ($13,814 versus $4,884 for localised/regional disease). The estimated overall direct health services cost of ovarian cancer in 2013 was AUD$99million (4,700 women nationally).

Conclusion: The excess health system costs of ovarian cancer are substantial. Continued investment in ovarian cancer research, particularly prevention, early detection and more effective personalised treatments is necessary to reduce the burden of disease.

Copyright: © 2023 Goldsbury et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Costs and Cost Analysis
Female
Health Care Costs
Health Services*
Hospitalization
Humans
Ovarian Neoplasms* / epidemiology
Ovarian Neoplasms* / therapy

Grants and funding

AV received a postdoctoral fellowship funded by the Fussell Family Foundation to support work relating to ovarian cancer. No funder had a role in study design, analysis, decision to publish, or preparation of the manuscript. PMW received grant funding from AstraZeneca for an unrelated study of ovarian cancer, and a speaker’s fee from AstraZeneca. ADF received grant funding from AstraZeneca for an unrelated study of ovarian cancer. DEG, MFW, JS and KC are investigators on a study of cancer patient population projections, funded by the Australian Government Medical Research Future Fund (MRFF) – Preventive and Public Health Research Initiative – 2019 Targeted Health System and Community Organization Research Grant Opportunity (MRF1200535). KC receives salary support from the National Health and Medical Research Council Australia (APP1194679). KC is co-PI of an investigator-initiated trial of cervical screening, "Compass", run by the Australian Centre for Prevention of Cervical Cancer (ACPCC), which is a government-funded not-for-profit charity. Compass receives infrastructure support from the Australian government and the ACPCC has received equipment and a funding contribution from Roche Molecular Diagnostics, USA. KC is also co-PI on a major implementation program Elimination of Cervical Cancer in the Western Pacific which has received support from the Minderoo Foundation and the Frazer Family Foundation and equipment donations from Cepheid Inc. Neither KC nor their institution (the Daffodil Centre, a joint venture between Cancer Council NSW and The University of Sydney) receive direct funding from commercial organisations.