The cost of cancer care in Singapore: A population-based analysis of healthcare expenditures and survivorship.

Abstract

e23397 Background: Cancer is the leading cause of death in Singapore and advances in diagnostics and therapeutics have increased healthcare expenditure. However, population-level studies examining rising costs and survival gains across cancer types remains limited. We aim to quantify the direct medical costs of cancer care in Singapore and evaluate how changes in expenditure relate to survival gains across cancer types, disease stages, and phases of care. Methods: This population-based study included 103,243 individuals diagnosed with 1 of the 15 common cancers in Singapore between January 1, 2005, and December 31, 2016. Data were obtained from the national cancer registries and linked administrative healthcare databases through the Trusted Research and Real-World Data Utilisation and Sharing (TRUST) platform. Patients were followed through December 31, 2020. Direct medical costs were estimated from a health system perspective and inflation-adjusted to 2020 Singapore dollars (SGD). Costs were analysed by cancer type, phase of care and disease stage. Survival was assessed using restricted mean survival time (RMST). We assessed change in cost per discounted life-year gained across two time periods (modified ICERs). Results: Total first-year cancer expenditures increased from SGD 135.3 million (mil) in 2005 to SGD 400.4 mil in 2016, while cumulative five-year costs rose from SGD 195.0 mil to SGD 672.0 mil. Mean per-patient first-year costs increased from SGD 20,600 to SGD 36,200 and five-year costs more than doubled from SGD 29,700 to SGD 60,800. Initial treatment accounted for the largest share (50.4%; SGD 2.32 billion), followed by end-of-life care (35.4%; SGD 1.60 billion). Mean per-patient initial-phase costs were highest for myeloid cancer (SGD 70,900), lymphoid cancer (SGD 66,700), and pancreatic cancer (SGD 48,800). Inpatient services constituted the largest percentage of five-year expenditures, with per-patient inpatient costs increasing from SGD 25,600 in 2005–2008 to SGD 35,800 in 2013–2016 (compound annual growth rate (CAGR), 3.66%). Outpatient expenditures grew most rapidly from SGD 18,600 to SGD 41,200 per patient (CAGR, 7.48%). Stage IV cancers had the fastest cost growth (CAGR, 8.8%), exceeding stage I (2.4%), stage II (6.0%), and stage III (6.0%) disease. Survival gains varied across cancers, with RMST increase from 0.04 to 0.34 years. Corresponding modified ICERs ranged from SGD 750 per dLYG for myeloid cancers to SGD 94,450 per dLYG for prostate cancer. Conclusions: Cancer care in Singapore has become more resource intensive with wide variation in the value across cancer types. While survival outcomes have improved, gains have not consistently matched rising expenditures. These findings highlight the need for value-based cancer policies that align resource allocation with measurable clinical benefit to ensure sustainable cancer care delivery.