Health system spending per case

Total spending across the health system on a particular disease or condition group is one measure of the financial burden due to disease and ill health. However, this does not give an indication of the relative number of people experiencing disease, or the amount spent on treating a single case. Total health spending for a condition may be high because treatments are expensive, or because the number of cases in the community is high. By estimating the health spending per case for a particular disease or condition, we can try to understand the drivers of total spending on disease, and where that spending is occurring in the health system. This information can also be used in health economic modelling to estimate what might happen to health spending if disease burden decreases over time or to assess the potential impact of new treatments and programs.

The expenditure estimates used to derive the spending per case estimates come from Disease expenditure in Australia 2018-19 and include spending on public and private hospitals, PBS pharmaceuticals, MBS services, and dental. This does not include some spending through private providers, or the aged care system. For information on the methods used to derive prevalence and spending per case, refer to the Technical notes of this report and the Australian Burden of Disease Study: Methods and Supplementary material 2018.

Key findings

  • The 5 specific conditions with the highest spending per case in 2018–19 were: chronic myeloid leukemia ($0.24 million), acute lymphoblastic leukaemia ($0.17 million), nasopharyngeal cancer ($0.14 million), myeloma ($0.11 million) and cystic fibrosis ($0.85 million).

  • In 2018–19, 16 of the top 20 conditions (80%) on a spending per case basis, came from the cancer and other neoplasms disease group.

  • Breast cancer spending was an estimated $61,000 per case, prostate cancer $50,000, cervical cancer $44,000 and lung cancer $29,000.

  • Among cardiovascular diseases, spending per case of aortic aneurysm was highest at around $68,000, followed by hypertensive heart disease ($22,000).

  • For mental health and substance use disorders, schizophrenia was the most expensive with spending of around $22,000 per case.

  • Multiple sclerosis was the most expensive neurological condition per case ($21,000) followed by Guillain-Barre syndrome at around $11,000.

Conditions with a prevalence count less than or equal to 4 for either males, females or total persons are not included in this analysis. In addition, benign and uncertain brain tumours, haemophilus influenzae type-b and all burden of disease conditions that contain ‘other’, ‘unknown’ or ‘uncertain’ in their description have all been excluded from the analysis due to the difficulty in obtaining reliable prevalence estimates for these conditions.

The first interactive data visualisation below shows the top 20 conditions with the highest spending per case in Australia in 2018–19. The second shows the spending per case for all burden of disease conditions where data is available. The third shows the average spending per case for each of the burden of disease groups. The data used to create the visualisations can also be downloaded as an Excel workbook.

This bar chart shows the top 20 burden of disease conditions with the highest health system spending per case by sex in 2018-19. At the disease conditions level, Hepatitis C (acute) had the highest spending per case at over $1 million spent per case for males in 2018-19 and around $800K for females. Benign and uncertain brain tumours, Hepatitis B (acute), Appendicitis and Chronic myeloid leukaemia (CML) had the next highest health system spending per case for both males and females.

This bar chart shows health system spending per case, by burden of disease groups and sex in 2018-19. Benign and uncertain brain tumours was the most expensive of all cancers, with the health system spending per case of $547K for females and $489K for males in 2018-19. Appendicitis was another expensive condition at around $260K on average per case for males and females.

This bar chart shows the average health system spending per case by disease group and sex. Cancer and neoplasms had the highest average health system spending per case for both females and males at around $12,000. Infant and congenital conditions was the group with the second highest average spending per case for females at $5,104 whereas for males, the average spent on the same group was $2,403.