Impact of Stage at Cancer Diagnosis on Total Healthcare Costs: A National Population-Based Study Using England Individual-Level Patient Data

OBJECTIVES: Cancer early detection interventions can provide benefits such as reduced cancer mortality. To understand the cost effectiveness of delivering these benefits requires estimates of healthcare costs across different stages at diagnosis. We estimate the mean total healthcare costs per cancer patient in England by stage at diagnosis for eight cancer types.

METHODS: We included patients aged 50–79 years diagnosed in 2014 with colorectum, head and neck, liver and bile duct, lung, oesophagus, ovary or pancreas cancer, or lymphoma. Using England cancer registration data linked to routine national healthcare datasets, we extracted healthcare events from 6 months before to 6 years after diagnosis, censoring follow-up at death or 31 Dec 2019, whichever was earlier. Costs were assigned to events using the NHS HRG4+ grouper application. Healthcare events delivered in hospice/community settings, primary care and private healthcare were not captured.

RESULTS: Our analysis included 85,363 individuals. Estimated mean total healthcare costs per patient were higher for stage IV versus stage I lymphoma (£52,625 vs £38,420), colorectal (£42,452 vs £31,249), head and neck (£43,980 vs £32,095), and ovary (£49,264 vs £26,651) cancers; however, for the latter three cancers, costs were highest for stage III cancers.

CONCLUSIONS: The stage with which the highest cumulative healthcare costs were associated varied by cancer type. Future analyses will explore cost distributions across phases of cancer care, estimated net costs of cancer care, and factors affecting cost-by-stage differences.