Author: Margaret Holland, Adele Balram, Jonathan Boudreau, Ted McDonald
Year: 2018
Category:
Health Publications
The Firefighter’s Compensation Act (2009) — which granted firefighters presumptive coverage for select sites of primary cancer (i.e., bladder, brain, colorectal, kidney, leukemia, lung, non Hodgkin’s lymphoma, oesophageal, testicular, and ureter) — has both established precedent for workers in New Brunswick (NB) and liability for the Workers’ Compensation (WC) system. While occupational cancer has been shown to exert health and economic burden in other jurisdictions, little research has examined the health and economic burden of occupational cancer in New Brunswick. The aim of this study is to help fill that gap. Specifically, the goal of this report is to use what data are available to characterize the costs of cancer generally, which are then useful for providing an estimate of a cost range for a number of occupationally-related cancers.
The study made use of administrative health data held at the New Brunswick Institute for Research, Data and Training (NB-IRDT) for the period from 2008-2013 (the most recent available). Cancer patients were identified from the New Brunswick Provincial Cancer Registry (NBPCR), a population based cancer registry. An estimated 19,861 incident (new) cases of cancer were diagnosed during the study period. The most common incident cancers in the analytical sample were breast, prostate, lung, colon, and skin, comprising 66% of all incident cancers from 2008 to 2013.
Data on the cost and frequency of acute inpatient hospitalization were obtained from the New Brunswick Discharge Abstract Database (DAD). The DAD contains demographic, administrative, and clinical data on acute care institution separations in the province. The study utilized a phase of-care based approach to costing: inpatient hospitalizations were assigned to one of two clinically-relevant phases of care: the treatment phase (the 18-month period following the date of cancer diagnosis) and the terminal phase (last 12 months of life). Acute inpatient hospitalization costs varied by cancer site, stage of disease, phase of care, and age group. Expected costs of acute inpatient hospitalizations during the treatment phase were lowest for breast cancer ($9,441) and highest for leukemia ($35,963). Expected costs of acute inpatient hospitalizations during the terminal phase were lowest for kidney cancer ($17,044) and highest for non-Hodgkin's lymphoma ($49,028).
More in-depth analysis of cancer care costs in New Brunswick is limited by the nature and availability of relevant health care service utilization and cost data. As cancer patients journey through the provincial healthcare system, they use a variety of outpatient and community-based health care services. However, New Brunswick data on these aspects of a cancer patient’s journey (i.e., physician services, pharma care, diagnostic testing, emergency services, home care, long-term care, and hospice care) are limited. These components of cancer care have been shown to be important drivers of cost, accounting for anywhere from 36% to 62% of mean per patient cancer care cost in Ontario for patients who survived less or more than 12 months from diagnosis, respectively.
As outpatient- and community-based health cancer care can also be expected to be important cost drivers in New Brunswick, estimates including these components were simulated by site and stage of cancer for the ‘typical’ patient following ‘standard treatment’ under various scenarios (high, medium, and low cost) using available data (e.g., fee schedules, collective agreements, peer-reviewed scholarly articles, and clinical treatment guidelines). The simulated expected costs were lowest for prostate cancer ($20,894) and highest for brain cancer ($92,597). Simulated cost modeling creates a foundation to further understanding of and research on the nature of the cancer burden in the province. However, simulated cost estimates for the ‘typical’ patient are not a substitute for estimates based on real health care service utilization data. More information and real patient- and systems-level data are needed to fully appreciate the cost implications of a case of cancer in New Brunswick for health care and wellness planning and for evaluating the appropriateness and effectiveness of cancer care delivered throughout New Brunswick.
The study identifies other knowledge gaps in the cancer registry data. For example, while most cancer patients in New Brunswick begin involvement with the cancer care system via diagnostic tests that describe extent and severity (cancer staging) of their disease, limited staging information is reported to the provincial cancer registry (i.e., only breast, colon, lung, prostate, and rectal cancers are staged in the NBPCR). Research in other jurisdictions suggests that these disease distinctions are important to fully understand cancer burden. As such, staging information is important for evaluating the effectiveness of prevention programming and cancer care delivered throughout New Brunswick.
Another limitation of the existing cancer registry infrastructure is that the provincial and national cancer registries do not collect workplace and exposure information. This information gap has two noticeable effects. First, known (and suspected) cases of occupational cancer are not identifiable outside of insurance claims data. Second, it difficult to estimate the extent of occupational exposure to carcinogens and the impact(s) of such exposure in the province. Studies from other jurisdictions have suggested that up to 40% of the workforce may be exposed to carcinogenic agents at the workplace or in an occupation. This data is essential for understanding the nature of the occupational cancer burden and for evaluating the effectiveness of workplace health and safety cancer prevention initiatives in the province.
