Oral Presentation NSW State Cancer Conference 2023

Out-of-pocket healthcare costs for people with and without cancer in NSW (#22)

David E Goldsbury 1 2 , Philip Haywood 2 3 4 , Alison Pearce 1 2 , Louisa G Gordon 5 , Deme Karikios 6 7 , Gill Stannard 8 , Karen Canfell 1 2 , Julia Steinberg 1 2 , Marianne F Weber 1 2
  1. The Daffodil Centre, a joint venture between The University of Sydney and Cancer Council NSW, Sydney, NSW, Australia
  2. Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
  3. Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
  4. Health Division, Directorate for Employment, Labour and Social Affairs, Organisation for Economic Co-operation and Development (OECD), Paris, France
  5. Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
  6. Department of Medical Oncology, Nepean Hospital, Sydney, NSW, Australia
  7. Nepean Clinical School, The University of Sydney, Sydney, NSW, Australia
  8. Cancer Voices NSW, Sydney, NSW, Australia

Background: Out-of-pocket (OOP) costs for healthcare in Australia are estimated at ~AUD$30 billion annually, potentially placing a substantial burden on those affected by disease. We aimed to describe person-level OOP healthcare costs, with a focus on costs by cancer status.

 

Methods: We analysed self-reported OOP healthcare costs using the Sax Institute's 45 and Up Study in NSW (n=267,357 recruited at baseline 2005-2009), among participants who completed a follow-up questionnaire sent out in 2020. The questionnaire included several categories of health costs and detailed sociodemographic information. Cancer information was included via linkage with the NSW Cancer Registry1,2. Logistic regression was used to test for associations between higher OOP costs (>$1000 and >$10,000) and cancer status, adjusting for participants' characteristics.

 

Results: There were 45,061 respondents, with 43% reporting >$1000 in OOP costs for their healthcare in the previous 12 months. Cost types with higher OOP costs included doctors/specialists (10% >$1000), dental care (10% >$1000), and medications (6% >$1000). People diagnosed with cancer in the previous two years (n=861) were more commonly in the higher OOP cost categories (55% >$1000 total spend, adjusted odds ratio (aOR) 2.14 vs. no cancer (42% >$1000) [95% confidence interval 1.82-2.52]), as were people diagnosed >2 years prior (45%, aOR 1.22 vs. no cancer [1.15-1.29]). OOP costs >$1000 were also associated with socioeconomic advantage, particularly private health insurance and higher household income. OOP costs >$10,000 were strongly associated with recent cancer diagnoses (9% vs. 3% for no cancer, aOR 3.30 [2.56-4.26]).

 

Conclusions: Many people reported substantial OOP healthcare costs. While higher OOP costs were generally associated with higher socioeconomic advantage, costs were also higher for people recently diagnosed with cancer, increasing the burden on patients at a time of vulnerability. This is especially concerning for maintaining equitable health outcomes for those with limited financial resources.

 

  1. Linkage undertaken by the Centre for Health Record Linkage (CHeReL, www.cherel.org.au).
  2. Secure data access was provided through the Sax Institute’s Secure Unified Research Environment (SURE).