Comparison of predictors for long-term survival and healthcare costs of cancer patients in Scotland

BACKGROUND: New cancer treatments can improve prognosis, but may impact on the sustainability of health systems due to additional healthcare use by survivors of cancer. This study compared predictors of long-term healthcare costs with predictors of survival in a national cohort of people with cancer, with an aim of identifying factors associated with both improved survival and reduced costs. METHODS: This was a retrospective cohort study using linked administrative healthcare data from NHS Scotland. Participants were people diagnosed with a first malignant cancer (1st Jan 2009 to 31st Dec 2010). The outcomes were incident healthcare costs derived from inpatient episodes, outpatient visits and prescription costs. Univariable and multivariable Cox and GLM regressions were used to evaluate the predictors (age, sex, area deprivation, method of detection, pre-diagnosis costs, rurality, region, stage of detection, comorbidities). RESULTS: 55,807 individuals with cancer were followed over eight years after diagnosis and found to incur substantial healthcare costs (mean £29,460 at 2017 GBP, 95% CI £29,199 to £29,720). Variables negatively associated with costs tended to be positively associated with hazard of death, e.g., age > =80 (adjusted cost ratio 0.55, p < 0.001; adjusted hazard ratio 5.94, p < 0.001), stage IV (adjusted CR 0.69, p < 0.001; adjusted HR 3.14, p < 0.001), history of dementia (adjusted CR 0.51, p < 0.001; adjusted HR 1.69, p < 0.001). Only screening as a method of first detection was significantly associated with both lower costs (adjusted CR 0.85, p < 0.001) and lower hazard of death (adjusted HR 0.30, p < 0.001). CONCLUSIONS: Screening was associated with both improved survival and reduced healthcare costs. These results support the current priorities of national public health agencies and research funders to focus investment on improving early diagnosis. KEY MESSAGES: • Factors associated with reduced post-diagnosis healthcare costs tended to be associated with poorer survival. • Screening was associated with reduced healthcare costs and better survival.