Background
Treatment for keratinocyte cancers (KC) places a huge burden on the Australian healthcare system. Little is known about the relative proportions of patients receiving treatment from primary care practitioners (PCP) versus specialists; nor about the proportion treated in hospital.
Aim
To describe the settings in which KC are excised and the practitioners who excise them, and examine costs and determinants of hospital treatment.
Method
We used linked data for participants from the QSkin study (n=43,764), including data from Medicare and Queensland hospital admissions relating to treatment episodes for first incident KC. We used multinomial logistic regression to measure the association between demographic and clinical characteristics and the treatment setting.
Results
6933 patients (17%) had at least one KC excised during follow-up. Of first excisions, 89.8% were treated in private clinical rooms, the remainder were treated in hospitals (8.3% private; 1.9% public). KC on the nose, eyelid, ear, lip, finger or genitalia were more likely to be treated in public (OR 6.6; 95%CI 4.4-9.8) or private hospitals (OR 7.3; 95%CI 6.0-8.9) than in private rooms. PCP excised 83% of all KC, followed by plastic surgeons (9%) and dermatologists (6%). The median Medicare benefit paid for each excision was $255 in private rooms and $395 in private hospitals. Patient out-of-pocket costs were 5-fold higher in private hospital compared with private rooms ($453 vs $80).
Conclusions
Our findings are important for future planning and resource allocation given the ageing population and rising rates of excisions for KC among older Australians.