End-of-life healthcare use and associated costs for First Nations Australians diagnosed with cancer in Queensland, Australia

Purpose: Cancer significantly impacts First Nations Australians, with higher incidence and lower survival rates. However, understanding of end-of-life (EOL) service use and costs in this population is limited. We aimed to assess EOL healthcare utilisation and costs for First Nations cancer patients in Queensland, Australia. 

Methods: Retrospective data from CancerCostMod, a linked administrative dataset of all cancer diagnoses in Queensland, were used. This dataset includes records from the Queensland Cancer Registry (QCR) from July 1, 2011, to June 30, 2015, linked to Queensland Health Admitted Patient Data Collection (QHAPDC), Emergency Department (ED) Information Systems, Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) data from July 2011 to June 30, 2018. All diagnosed cancer patients who had died during the study period (N = 467) were included. Health service usage and costs during the last 6 months of life were described and compared across care type, comorbidity status, age group, and residential remoteness using Mann–Whitney and Kruskal–Wallis tests. 

Results: Individuals had at least one hospital episode (100%), ED visit (83%), MBS claim (96%), and PBS claim (96%). The median overall cost per person for hospital episodes was AUD$40,996, with higher costs for those receiving palliative care (AUD$43,521) and chemotherapy (AUD$50,437) compared to those who did not receive these services (palliative: AUD$34,208, chemotherapy: AUD$38,557). Having comorbidities and living in regional and remote areas were associated with higher hospital costs. 

Conclusion: The study findings may guide the re-design and delivery of optimal and culturally appropriate EOL care for First Nations Australians diagnosed with cancer.