title: Phase-specific and lifetime costs of cancer care in Ontario, Canada.
abstract: Cancer is a major public health issue and represents a significant economic burden to health care systems worldwide. The objective of this analysis was to estimate phase-specific, 5-year and lifetime net costs for the 21 most prevalent cancer sites, and remaining tumour sites combined, in Ontario, Canada.
  
  
  
  We selected all adult patients diagnosed with a primary cancer between 1997 and 2007, with valid ICD-O site and histology codes, and who survived 30 days or more after diagnosis, from the Ontario Cancer Registry (N = 394,092). Patients were linked to treatment data from Cancer Care Ontario and administrative health care databases at the Institute for Clinical and Evaluative Sciences. Net costs (i.e., cost difference between patients and matched non-cancer control subjects) were estimated by phase of care and sex, and used to estimate 5-year and lifetime costs.
  
  
  
  Mean net costs of care (2009 CAD) were highest in the initial (6 months post-diagnosis) and terminal (12 months pre-death) phases, and lowest in the (3 months) pre-diagnosis and continuing phases of care. Phase-specific net costs were generally lowest for melanoma and highest for brain cancer. Mean 5-year net costs varied from less than $25,000 for melanoma, thyroid and testicular cancers to more than $60,000 for multiple myeloma and leukemia. Lifetime costs ranged from less than $55,000 for lung and liver cancers to over $110,000 for leukemia, multiple myeloma, lymphoma and breast cancer.
  
  
  
  Costs of cancer care are substantial and vary by cancer site, phase of care and time horizon analyzed. These cost estimates are valuable to decision makers to understand the economic burden of cancer care and may be useful inputs to researchers undertaking cancer-related economic evaluations.
authors.affiliation: Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Room T414, Toronto, ON, M5S 2S1, Canada. claire.deoliveira@camh.ca.
authors.forename: Claire
authors.initials: C
authors.lastname: de Oliveira
authors.affiliation: Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Agency, 675 W 10th Ave., Vancouver, BC, V5Z 1L3, Canada.
authors.forename: Reka
authors.initials: R
authors.lastname: Pataky
authors.affiliation: Toronto General Hospital, University Health Network, 200 Elizabeth Street, Room EN13-222A, Toronto, ON, M5G 2C4, Canada.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Bremner
authors.affiliation: Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, G1 72, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
authors.forename: Jagadish
authors.initials: J
authors.lastname: Rangrej
authors.affiliation: Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 58, Toronto, ON, M4N 3M5, Canada.
authors.forename: Kelvin K W
authors.initials: KK
authors.lastname: Chan
authors.affiliation: British Columbia Cancer Agency, 600 W. 10th Ave, Vancouver, BC, V5Z 4E6, Canada.
authors.forename: Winson Y
authors.initials: WY
authors.lastname: Cheung
authors.affiliation: University of California Davis, 2315 Stockton Blvd., Sacramento, CA, 95817, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hoch
authors.affiliation: British Columbia Cancer Agency, 675 W 10th Ave., Vancouver, BC, V5Z 1L3, Canada.
authors.forename: Stuart
authors.initials: S
authors.lastname: Peacock
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative, 144 College Street, Rm 600, Toronto, ON, M5S 3M2, Canada.
authors.forename: Murray D
authors.initials: MD
authors.lastname: Krahn
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009369:Neoplasms / Q000175:diagnosis / Q000628:therapy*; D009864:Ontario; D012042:Registries / Q000706:statistics & numerical data*
keywords: Administrative data; Cancer; Cost and cost analysis; Health care costs; Neoplasms