In Australia, as in other parts of the world, the cost of providing cancer care is growing, due to a combination of increased incidence of cancer and rising treatment costs. In Australia, between 2001 and 2009, the incidence of cancer increased by 29%, from 90,146 to 116,170.1 Over the same period, cost of cancer care increased over 56% from $2.9b to $4.5b.2 At the same time, there is significant variation in the cost of care, with higher costs not being correlated with better outcomes. The challenge faced by the healthcare system is how to maximise value by constraining cost growth while maintaining high (and improving) quality of care.
In Australia, between the periods 1982–1987 and 2006–2010, 5-year survival rose from 47% to 66%.3 As survival rates increase, mortality is an important but insufficient measure of the outcome of cancer care and therefore is only part of what needs to be considered in determining value. An important yardstick for measuring outcomes, and therefore determining value, is what matters to patients.
On the other side of the value equation, most of the cost of cancer treatment in Australia is incurred in the inpatient setting, accounting for 79% of cost in 2008-09. Together, inpatient care and pharmaceutical costs made up over 90% of the cost of cancer care. There are opportunities to shift more cancer care to community and home settings, while maintaining quality of care and delivering patient-centred outcomes.
This presentation will explore the opportunities and challenges involved in linking cost and outcomes data with models of care for treating cancer. There are opportunities to introduce greater flexibility and create incentives to provide appropriate, lower-cost care through changes to funding models such as the use of bundled payments or capitation. Linking funding flexibility to the use of agreed, transparent patient-reported outcome measures creates the opportunity to drive increased value in the provision of cancer care. The challenges include getting the right incentives in place to support high quality, low cost care; and ensuring effective clinical engagement in the development of new approaches.