Overview
Cacing the economic burden of cancer requires looking beyond incidence and mortality to how hospitalization costs accumulate. A retrospective study using the CNHSNRS data from 2017–2019 in Hunan Province, China, quantified inpatient spending for all cancers, described the cost distribution across cancer sites and patient characteristics, and identified factors associated with higher per-admission costs. The findings reveal that lung, colorectal, breast, liver, and stomach cancers together account for about half of all cancer-related hospital costs in Hunan, underscoring areas where prevention and early treatment could ease financial strain.
What the study looked at
The analysis included 872,309 hospitalization records with a principal cancer diagnosis (ICD-10 C00–C97) after excluding carcinomas in situ. Key variables included age, sex, cancer site, comorbidities, hospital level, hospital location, length of stay (LOS), and payer type. Costs were adjusted to 2017 CNY and converted to US dollars for international comparability. The main outcome was direct hospitalization cost per admission, with costs stratified by cancer type and patient characteristics; indirect and nonmedical costs were not captured.
Main findings
Overall burden
From 2017 to 2019, total cancer hospitalization costs in Hunan reached about US$2.49 billion, with medical insurance covering 64.1% of these costs. The mean patient age was around 59 years, and nearly half of patients were female. Most admissions occurred at tertiary hospitals, reflecting the concentration of specialized cancer care in higher-tier facilities. Median LOS was nine days, a substantial driver of inpatient costs.
Top-cost cancers by sex
In men, the five costliest cancers (by total spend) were lung, colorectum, liver, lip/oral cavity/pharynx, and stomach. In women, the top five were breast, colorectum, cervix, lung, and thyroid. Across all cancers, the five sites in men and women together accounted for more than half of total cancer hospitalization costs. Lung and colorectum cancers consistently stood out as major cost centers for both sexes.
Per-admission cost and determinants
Individual-level analyses showed that per-admission costs were highest for brain tumors, followed by lip/oral cavity/pharynx, leukemia, kidney, and colorectum cancers. In multivariable models, factors linked with higher costs included: cancer site, male sex, older age, more comorbidities, longer LOS, admission to tertiary hospitals, and admission in the provincial capital (Changsha). Interestingly, costs varied over the study years, suggesting evolving treatment patterns or pricing dynamics.
<h2Interpretation and implications
The study confirms that cancer imposes a substantial economic burden in Hunan, with lung, colorectal, breast, liver, and stomach cancers contributing to the majority of inpatient costs. Several determinants—clinical and institutional—shape per-admission costs. For policymakers, the results underscore the potential benefits of expanding early detection and screening (which may reduce advanced-stage hospitalizations), strengthening insurance coverage for high-cost therapies, and directing prevention resources toward high-burden cancer sites.
Policy relevance and recommendations
- Enhance early diagnosis and treatment programs for lung and colorectal cancers to prevent costly inpatient care later.
- Address out-of-pocket payments, which comprised a sizable portion of costs, by expanding insurance coverage for high-cost cancer therapies.
- Support tertiary hospitals with appropriate funding while ensuring efficient care pathways to reduce LOS where feasible.
- Continue monitoring regional cancer spending to evaluate the impact of screening initiatives and new therapies on cost trajectories.
Limitations
Limitations include the absence of outpatient and indirect costs, lack of cancer-stage data, and inability to track cost trajectories for individual patients due to anonymized records. These factors likely lead to underestimation of the true economic burden and limit the ability to attribute costs to specific treatment regimens or disease severities.
Conclusion
Hospital spending for cancers in Hunan from 2017–2019 was substantial, with half of the total costs driven by lung, colorectum, breast, liver, and stomach cancers. Patient-, disease-, and hospital-level characteristics consistently influenced per-admission costs. The findings highlight the economic value of early detection, equitable insurance coverage, and cost-aware cancer control strategies in reducing the financial burden on individuals and the healthcare system.
