# Understanding Diagnostic Costs Using Hospital-Based Encounters in the Year Before Diagnosis for Canadian Patients with Malignant Central Nervous System Tumours Compared to Common Cancers

## TL;DR

This study compares the healthcare costs before diagnosis for Canadian patients with rare CNS tumors and common cancers, finding higher costs for CNS tumor patients.

## Contribution

The study provides new insights into the financial burden of diagnosing rare cancers, specifically malignant CNS tumors, in Canada.

## Key findings

- Healthcare expenditures for CNS tumor patients were higher than those for common cancers.
- Encounter type, province, and comorbidities were the top factors affecting healthcare cost variation.
- The study highlights the need for further investigation into cost differences for rare cancers.

## Abstract

Rare cancers pose significant diagnostic challenges, leading to more tests and higher healthcare expenditures (HEs). Understanding the financial implications of diagnosing rare cancers is crucial, particularly in Canada, where overall HEs are high (12% of the GDP in 2023). We investigated the pre-diagnostic hospital–based HE for patients with malignant central nervous system (CNS) tumours and compared it to patients with common cancers across Canadian provinces, using in-patient and ambulatory care data (2010–2014) from the Canadian Institute for Health Information. Pre-diagnostic HE was calculated as the change in total HE (in-patient and out-patient) during the 12 months before diagnosis, calculated as the HE within this period minus the average annual HE estimated over the two preceding years. Comparison groups included pediatric patients diagnosed with leukemia and patients aged over 15 diagnosed with colorectal cancer and lung cancer. We used quantile regression to estimate the adjusted effect of diagnosis with a CNS tumour on pre-diagnostic HE. The results indicated that HE for CNS patients was higher compared to those with common cancers. The top three factors contributing to HE variation were encounter type (in-patient/out-patient), province (Alberta/Ontario), and comorbidities (yes/no). Further investigation is warranted to understand the drivers of the cost differences.