Overview
Cocusing on the financial burden of cancer care, this study examines hospitalization spending for all cancers in Hunan Province, China, from 2017 through 2019. Using hospital admission data, the analysis identifies which cancer types consumed the most resources and what patient- and hospital-related factors were associated with higher per-admission costs. The findings offer insights for policymakers aiming to optimize cancer screening, treatment, and financing in a rapidly aging Chinese population.
What was spent and by whom
The dataset included 872,309 hospitalizations for cancer in Hunan over the three-year period, with a total hospitalization cost of about US$2,490 million. Insurance covered roughly 64% of these costs, while out-of-pocket payments accounted for the remaining 36%. This distribution underscores the important role of medical insurance in mitigating the economic burden of cancer, while still leaving substantial financial responsibility with patients and families.
Cancer types driving the cost
Across sexes, the cancers contributing most to total spending were lung, colorectal, breast, liver, and stomach cancers. In men, the top five costs were lung, colorectum, liver, lip/oral cavity/pharynx, and stomach cancers. In women, the largest contributors were breast, colorectum, cervix, lung, and thyroid cancers. Collectively, these sites accounted for about half of all cancer-related inpatient costs in Hunan during 2017–2019.
Per-admission cost patterns
The study also analyzed cost per admission after a log transformation to account for skewness. Highest per-admission costs were seen for brain tumors, followed by lip/oral cavity/pharynx cancers, leukemia, kidney cancers, and colorectum cancers. Several factors consistently predicted higher per-capita costs: cancer site, male sex, older age, more comorbidities, longer length of stay (LOS), admission to tertiary hospitals, and admission in the provincial capital city, Changsha.
Key drivers of cost according to patient and hospital characteristics
Multiple regression identified several significant predictors of higher costs, including:
- Site of cancer: some tumors incur more expensive treatments or longer stays.
- Sex and age: men and older patients tended to have higher costs per admission.
- Comorbidity burden: more coexisting conditions were linked to higher costs and longer LOS.
- Hospital level and location: tertiary and capital(city) hospitals typically reported higher per-admission costs, likely reflecting higher complexity cases and advanced care options.
Policy and practice implications
The concentration of costs among a few cancer types suggests targeted prevention and early-detection efforts could yield meaningful savings. Given the World Health Organization and global cancer-control guidance, early diagnosis and timely treatment remain cost-efficient strategies. In China, ongoing health insurance reforms and risk-sharing arrangements could further reduce patient OOP expenditures, especially for high-cost cancers treated in tertiary or capital facilities. Strengthening primary-care access, refining referral pathways, and expanding coverage for innovative therapies may alleviate some financial stress on households.
Limitations
The analysis captured only direct medical costs associated with hospitalizations and did not include outpatient, nonmedical, or indirect costs. Some cancer-specific clinical details (stage, treatment modality) were not available, which may influence cost estimates. Additionally, the dataset could not track a patient’s cumulative expenditures across multiple admissions, potentially underestimating lifetime costs per patient.
Conclusion
From 2017 to 2019 in Hunan, cancer hospitalization costs totaled nearly US$2.5 billion, with roughly two-thirds covered by insurance. Lung and colorectal cancers emerged as dominant cost drivers, together with breast, liver, and stomach cancers. The study highlights how cancer type, patient characteristics, and hospital attributes shape the economic burden, offering a foundation for optimizing cancer control strategies and financing in China.
