This report provides a systematic analysis of Australian health expenditure in 2000–01 to treat or prevent cancer and other neoplasms, and to care for those with neoplastic disease. Cancer (also called malignant neoplasm) is a group of diseases characterised by the uncontrolled proliferation of abnormal cells. Other neoplasms include benign, in situ and unspecified neoplasms. Cancer and ‘other neoplasms’ are collectively called ‘neoplasms’.
Expenditure for cancer and other neoplasms in 2000–01 was $2.9 billion which was 5.8% of total health expenditure allocated by disease. The expenditures for cancer and other neoplasms attributed to the seven health sectors were as follows:
- Hospitals $1,988 million
- Out-of-hospital medical services $343 million
- Research $215 million
- Total pharmaceuticals $183 million
- Aged care homes $37 million
- Dental and other professional services $24 million
- Public health programs (non–MBS) $130 million
Expenditure in hospitals was 68% of expenditure for cancer and other neoplasms. In contrast, for all other diseases, 42% of expenditure was in hospitals.
Expenditure on cancers (malignant neoplasms) was $2.15 billion, with $634 million being spent for other neoplasms. The most expensive cancer was non-melanoma skin cancer (NMSC) ($264 million) followed by breast cancer ($241 million), colorectal cancer ($235 million) and prostate cancer ($201 million).
NMSC was the most common of all the cancers, with 364,000 new cases in 2001 (National Cancer Control Initiative, 2003). All other cancers together accounted for 88,400 new cases in 2001. The high frequency of NMSC means that although it was the most expensive cancer, it had the lowest cost per case (around $700 per NMSC removed).
Ninety per cent of expenditure on cancer was for treatment. Leukaemia had the highest lifetime treatment cost, at $51,000 per case.
Health expenditure on cancer by age and sex
Total expenditure on cancers was $1.2 billion for males and $0.9 billion for females.
The most expensive cancer for males was prostate cancer ($201 million). Of this expenditure, 48% was for non-hospital pharmaceuticals ($97 million).
Breast cancer was the most expensive cancer for females ($241 million). Of this expenditure, 40%was for organised mammography screening ($96 million).
NMSC was the second most expensive for both males ($153 million) and females ($111 million).
The most expensive cancers for boys and girls (aged 0–14) were leukaemia and brain cancer. Males accounted for higher expenditure than females. For leukaemia, $10 million was for males and $8 million for females. For brain cancer, $3.4 million was for males and $3.1 million for females.
In the 15–24 age group, leukaemia and bone and connective tissue cancer had the highest expenditure for both males and females. Again, expenditure on these two cancers was higher for males than for females. For leukaemia, $5.6 million was for males and $3.7 million was for females. For bone and connective tissue cancer, $1.5 million was for males and $1.4 million was for females.
The most expensive cancer for males in the 25–64 age group was NMSC ($53 million), followed by colorectal cancer ($43 million). For females in the 25–64 age group the most expensive was breast cancer ($89 million), followed by NMSC ($44 million).
In the group aged 65 and over, prostate cancer ($169 million) was the most expensive for males, followed by NMSC ($100 million). For females 65 and over, the most expensive was colorectal cancer ($74 million), followed by NMSC ($66 million).
Changes in treatment expenditure by disease, 1993–94 to 2000–01
The analysis of the change in expenditure has been conducted on treatment expenditure only. Total expenditure (in 2000–01 prices) on treatment of cancers increased $400 million (a 24% increase) in the period 1993–94 to 2000–01. The leading causes of the increase were prostate cancer ($97 million, a 93% increase), colorectal cancer ($72 million, a 44% increase), NMSC ($51 million, a 24% increase) and breast cancer ($31 million, a 30% increase). There was a 131% increase in expenditure per case for prostate cancer; this increase was due to greater use of community (non- hospital) pharmaceuticals in the treatment of prostate cancer.
Increases in expenditure for cancers were recorded for each of the age groups except the 15–24 age group and males aged 0–14 years. The greatest increases occurred in the group aged 65 and over, (38% for males, 25% for females and 32% for all persons).
The change in treatment expenditure for all cancer was $400 million, of which two– thirds was attributed to males ($257 million). Of this amount, 73%was in the group aged 65 and over and 23% was in the group aged 25–64.
Of the total expenditure on cancers and other neoplasms, 68% occurred in the hospitals sector, and 45% occurred in the group aged 65 and over. This age group accounted for 48% of all new cancer cases (58% if NMSC is excluded).
The real 18% increase in treatment expenditure for cancer (excluding NMSC and prostate cancer) between 1993–94 and 2000–01 is largely explained by an increase of 17% (1) in the number of cases of cancer not an increase in cost per case. However, prostate cancer did show a large increase in cost per case from $8,000 per case in 1993–94 to $18,000 per case in 2000–01, and this increase was the major reason that there was a 24% increase rather than a 18% increase in expenditure for cancers overall.