Overview: The Economic Burden of Cancer in Hunan (2017–2019)
The hospitalization expenditure for cancers in Hunan Province, China, from 2017 through 2019 reached US$2,490.36 million, illustrating a substantial economic burden on patients, insurers, and the health system. Across 872,309 cancer-related hospitalizations, medical insurance covered 64.10% of costs, while out-of-pocket payments accounted for 35.90%. These figures underscore the ongoing financial challenges posed by cancer even in a high-income country context and highlight regional patterns that can guide policy and planning.
Top Cancer Cost Drivers in Hunan
As with many regional cancer profiles, certain tumor sites dominated the total hospitalization costs. In men, the leading costliest cancers were lung, colorectum, liver, lip/oral cavity/pharynx, and stomach cancers. In women, the highest-cost cancers were breast, colorectum, cervix, lung, and thyroid cancers. Overall, lung and colorectal cancers emerged as the single largest contributors to total cancer costs, together with liver, stomach, and breast cancers. Importantly, these patterns account for roughly half of all cancer-related inpatient expenditures in the province.
Per-Admission Costs and Influencing Factors
The study identified several variables that significantly influenced per-admission costs after log transformation. Site of cancer, patient sex, age, year of hospitalization, number of comorbidities, length of stay (LOS), and hospital characteristics (level and location) all played meaningful roles. Notably, tertiary and capital (main city) hospitals tended to incur higher per-admission costs, a reflection of case complexity, service intensity, and the concentration of advanced therapies at higher-tier facilities.
Age, Comorbidity, and Hospital Characteristics
Cost patterns showed an age-related trend: peak spending occurred among middle-aged and older adults, with higher costs among those with multiple comorbidities and longer LOS. The highest per-admission costs were observed in cancers such as brain tumors and leukemias, illustrating that very costly therapies and complex care drive individual expenditure higher. The combination of advanced disease, multi-morbidity, and admission to tertiary hospitals contributes to elevated inpatient costs in this population.
Policy and Public Health Implications
China’s ongoing cancer screening and early-detection programs aim to reduce late-stage diagnoses and, consequently, inpatient costs. In Hunan, the data suggest that while insurance coverage mitigates part of the financial burden, a substantial portion—approximately a third—remains out-of-pocket. Strengthening insurance coverage for expensive therapies and ensuring affordable access to innovative cancer medicines could alleviate financial toxicity for patients. Moreover, the concentration of costs in high-tier hospitals points to a potential need for standardized care pathways and stronger referrals to optimize resource use without compromising outcomes.
Key Takeaways
- Total cancer hospitalization costs in Hunan (2017–2019): US$2.49 billion; 64.1% covered by insurance.
- Top cost drivers: lung and colorectal cancers, followed by breast, liver, and stomach cancers.
- Factors increasing per-admission costs: site of cancer, male sex, older age, more comorbidities, longer LOS, and admission to tertiary/capital hospitals.
- Policy implication: expand affordable access to early detection, reduce late-stage diagnoses, and address high OOP spending for cancer therapies.
Limitations and Scope for Future Research
The analysis focuses on hospitalization costs and does not capture outpatient, nonmedical, or indirect costs. Individual patient-level costs were not tracked over time due to anonymized data limitations. Future studies could link hospital data with outpatient records and cancer stage information to provide a more comprehensive view of the total economic burden and the effectiveness of screening programs in reducing inpatient expenditures.
