Background
Methods
Ethics
Economic approach
Epidemiological data
Calculating direct costs of skin cancer
Data sources
Data source | Abbreviation | Overview of data collected | Period of data collection | Number of possible records |
---|---|---|---|---|
45 and Up survey | 45& Up | The 45&Up survey is of individuals aged 45 and over in NSW - the survey includes information on health, lifestyle and other socio-economic factors. | 2005-2009 | 267,119 records (267,119 persons) |
NSW Central Cancer Registry | CCR | The CCR includes records for all reported cancer cases from NSW Central Cancer Registry. The CCR records include a range of demographic data items (e.g. date of birth, residential address), staging information, year of diagnosis, plus diagnostic information (e.g. reason for death, Morphology code, Topography Code etc.). The CCR cohort comprises individuals registered on NSW CCR and diagnosed with skin cancer (melanoma, melanoma in situ). | January 1994 – December 2008 | 63,342 records (60,247 persons) |
NSW Admitted Patient Data Collection | APDC | The APDC includes all hospital separations of skin cancer (melanoma, melanoma in situ, non-melanoma) and/or a precursor of skin cancer (sunburn, actinic keratosis or melanocytic naevi) in NSW during the period July 2000-Dec 2011 from all NSW public and private hospitals and day procedure centres. APDC records include a range of demographic data items, administrative items (e.g. admission and separation dates) and diagnostic information (e.g. reason for admission, significant co-morbidities and complications and procedures performed during the admission). | July 2000 – December 2011 | 406,997 records (256,924 persons) |
Australian Bureau of Statistics (ABS) mortality | ABS Mortality | The ABS cohort includes all cases where skin cancer is recorded as the primary or contributing cause of death. Cause of death is coded according to the International Statistical Classification of Diseases and Related Problems (ICD-10-AM). | January 2000 – December 2007 | 5735 records (5728 persons) |
Pharmaceutical Benefit Schedule | PBS | The PBS is administered by Medicare Australia and includes all processing claims and payment benefits for pharmaceutical medications for most medical conditions. This source contains cost and utilisation data by drug for each individual. | 2004-2011 | 35,322,2457 records |
Medicare Benefit Schedule | MBS | The MBS is a listing of medical and hospital services that are subsidised by the Australian government. The MBS includes primary care practitioner and specialist consultations and exclude ambulance and allied health services. This source contains costs (including patient out of pocket cost) and utilisation data by service/procedure. | 2003-2011 | 46,012,797 records |
NSW Registry of Births, Deaths and Marriages | RBDM deaths | The Registrar of the NSW Registry of Births, Deaths and Marriages (RBDM) is a registry all births and deaths in NSW | RBDM records linked to 45& Up, CCR, APDC and ABS | 66,786 records (62,688 persons) |
Diagnosis of skin cancer
Analysis criteria
Direct costs
Variables | Sources | Question/Variable | Data Format | Analysis summary |
---|---|---|---|---|
Medical Charges | APDC | Average costs per AR-DRGs (from government ‘Costs of Care’ reports | Continuous ($) | Averages and totals across diagnosis groups and periods |
MBS | Charges | Continuous ($) | Averages and totals across diagnosis groups and periods | |
PBS | Gross Price | Continuous ($) | Averages and totals across diagnosis groups and periods | |
Diagnoses Melanoma | CCR | Inclusion in the CCR | Inclusion | |
45& Up | Question: ‘Has a doctor ever told you that you have melanoma’? | Yes/No | Proportions | |
MBS | Relevant MBS Charges | Continuous ($) | Averages and totals across diagnosis groups and periods | |
APDC | Relevant Primary Diagnoses items | Continuous ($) | Averages and totals across diagnosis groups and periods | |
Diagnosis NMSC | 45& Up | Question: ‘Has a doctor ever told you that you have skin cancer (NMSC)’? | Yes/No | Proportions |
MBS | Relevant MBS Charges | Continuous ($) | Averages and totals across diagnosis groups and periods | |
APDC | Relevant Primary Diagnoses items | Continuous ($) | Averages and totals across diagnosis groups and periods | |
Diagnosis Calendar Year (melanoma) | CCR | Year of Diagnosis’ variable | Year | |
APDC | Date of Separation | Year | ||
45& Up | Question: ‘At what age were you told you had melanoma?’ (Allows calculation of year with variable ‘Year of Birth’) | Continuous | Averages and totals across diagnosis groups and periods | |
Diagnosis Calendar Year (NMSC) | 45& Up | Question: ‘At what age were you told you had skin cancer (NMSC)’ (Allows calculation of year with variable ‘Year of Birth’) | Continuous | Averages and totals across diagnosis groups and periods |
APDC | Date of Separation | Year | ||
Demographics | 45& Up | Year of birth | Year | Year |
Gender | Female/Male | Proportions | ||
Year of Death | RBDM | Year of death variable | Year | Year |
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ALC = average lifetime cost of skin cancers diagnosed in 2010;
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NPV = net present value -
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CM i = average annual cost per case of melanoma relative to year of diagnosis i ; -
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CNMSC i = average annual cost per case of NMSC relative to year of diagnosis i ; -
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IM = incidence of melanoma in 2010; -
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INMSC = incidence of NMSC in 2010.
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Calculating indirect costs of skin cancer
Morbidity estimates
Premature mortality
Results
Epidemiology
Melanoma | NMSC | |||
---|---|---|---|---|
Males | Females | Males | Females | |
Incidence | ||||
Incident cases | 2295 | 1502 | 86,812a | 61,798a |
Incidence rate per 100,000 | 65 | 42 | 2449 | 1716 |
Morbidity | ||||
Total years lived with disease | 19,332 | 7089 | 9933 | 2533 |
Average healthy years of life lost due to disease | 3.66 | 1.77 | 0.05 | 0.02 |
Mortality | ||||
Deaths (2010) | 359 | 155 | 104 | 41 |
Total years of life lost | 3353 | 1571 | 566 | 104 |
Average years of life lost | 9.34 | 10.14 | 5.44 | 2.53 |
Mortality before the age of 65 years | ||||
Average years of productive life lost | 4.52 | 5.14 | 2.07 | 0.88 |
Economic cost of skin cancer
Melanoma | NMSC | Total | |
---|---|---|---|
Incident cases | |||
Female | 1502 | 61,798b | 63,300 |
Males | 2295 | 86,812b | 89,106 |
Total | 3797 | 148,610b | 152,407 |
Direct costs | |||
Females | $16,349,530 | $230,717,528 | $247,067,059 |
Cost per female incident case | $10,882 | $3733 | $3903 |
Males | $22,494,516 | $116,426,574 | $138,921,090 |
Cost per male incident case | $9803 | $1341 | $1559 |
Total | $38,844,046 | $347,144,102 | $385,988,148 |
Cost per incident case | $10,230 | $2336 | $2533 |
Indirect costs | |||
Females | $34,928,193 | $2,259,156 | $37,187,349 |
Cost per female incident case | $23,249 | $37 | $587 |
Males | $96,325,255 | $16,016,487 | $112,341,742 |
Cost per male incident case | $41,977 | $184 | $1261 |
Total | $131,253,448 | $18,275,643 | $149,529,091 |
Cost per incident case | $34,567 | $123 | $981 |
Total costs | $170,097,494 | $365,419,746 | $535,517,240 |
Cost per incident case | $44,796 | $2459 | $3514 |
Discussion
Limitations
Strengths
Comparability with other studies
Study | Country | Year and currency | Cases | Direct cost (million) | Indirect costs (million) | Total cost (million) | Cost per case | Equivalent AUD $2010 |
---|---|---|---|---|---|---|---|---|
Morris | England | 2002 UK pounds | ||||||
Melanoma | 6062 | £24 | £114 | £138 | £22,835 | $67,537 | ||
NMSC | 50,394 | £97 | £5 | £101 | £2014 | $5955 | ||
Skin cancer | 56,456 | £121 | £119 | £240 | £4249 | $12,567 | ||
Tinghog | Sweden | 2005 Euros | ||||||
Melanoma | 2122 | € 22 | € 58 | € 80 | € 37,545 | $66,738 | ||
NMSC | 36,262 | € 31 | € 5 | € 36 | € 998 | $1775 | ||
Skin cancer | 38,384 | € 53 | € 63 | € 116 | € 3019 | $5366 | ||
O’Dea | New Zealand | 2007/8 NZ dollar | ||||||
Melanoma | 1982 | $6 | $59 | $65 | $32,795 | $30,326 | ||
NMSC | 67,000 | $51 | $7 | $58 | $867 | $802 | ||
Skin cancer | 68,982 | $57 | $66 | $123 | $1785 | $1650 | ||
AIHW | Australia | 1993-94 AUD | ||||||
Melanoma | 6954 | $66 | $66 | $9433 | $14,805 | |||
NMSC | 243,691 | $232 | $232 | $953 | $1496 | |||
Skin cancer | 250,645 | $298 | $298 | $1189 | $1865 | |||
AIHW | Australia | 2000-01 AUD | ||||||
Melanoma | 8885 | $30 | $30 | $3376 | $4561 | |||
NMSC | 364,140 | $264 | $264 | $725 | $979 | |||
Skin cancer | 373,025 | $294 | $294 | $788 | $1065 |