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Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association

The impact of management option on out-of-pocket costs and perceived financial burden among men with localised prostate cancer in Australia within 6 months of diagnosis

Daniel Lindsay A B * , Penelope Schofield C D E , Doreen Nabukalu A , Matthew J. Roberts E G H , John Yaxley B F I , Stephen Quinn J , Natalie Richards D , Mark Frydenberg K L , Robert Gardiner B F G , Nathan Lawrentschuk M N O , Ilona Juraskova P , Declan G. Murphy E Q and Louisa G. Gordon A B R
+ Author Affiliations
- Author Affiliations

A Health Economics, Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, Qld 4006, Australia.

B Faculty of Medicine, The University of Queensland, Qld, Australia.

C Department of Psychology, Swinburne University of Technology, Melbourne, Vic., Australia.

D Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.

E Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Vic., Australia.

F Department of Urology, Royal Brisbane and Women’s Hospital, Qld, Australia.

G Centre for Clinical Research, The University of Queensland, Qld, Australia.

H Department of Urology, Redcliffe Hospital, Qld, Australia.

I Wesley Urology Clinic, Wesley Hospital, Qld, Australia.

J Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Vic., Australia.

K Department of Urology, Cabrini Institute, Cabrini Health, Vic., Australia.

L Department of Surgery, Monash University, Melbourne, Vic., Australia.

M EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, Vic., Australia.

N Department of Surgery, University of Melbourne, Melbourne, Vic., Australia.

O Department of Surgery, Royal Melbourne Hospital, Melbourne, Vic., Australia.

P Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, University of Sydney, Sydney, NSW, Australia.

Q Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.

R School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Qld, Australia.

Australian Health Review
Submitted: 14 October 2023  Accepted: 26 January 2024  Published: 12 February 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.



This study aimed to quantify the out-of-pocket (OOP) costs and perceived financial burden among Australian men with localised prostate cancer in the first 6 months after diagnosis, by primary management option.


This cost-analysis quantified OOP costs using administrative claims data and self-reported survey data. Financial burden was assessed using the COmprehensive Score for financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT) tool. Participants were recruited into a randomised control trial from public or private treatment centres in Victoria and Queensland. Generalised linear models were used to predict OOP costs and COST-FACIT scores.


Median total OOP costs within 6 months of diagnosis for 256 Australian patients with localised prostate cancer was A$1172 (A$343–2548). Up to 50% of the sample reported A$0 costs for most medical services. Compared with those managed with active surveillance, men having active treatment had 6.4 (95% CI: 3.2–12.7) times greater total OOP costs. Management option, higher Gleason score at diagnosis and having multiple comorbidities were significant predictors of higher OOP costs. Overall high scores on the COST-FACIT indicated low levels of financial burden for the entire sample.


Largely attributable to being managed with active surveillance, Australian men diagnosed with localised prostate cancer reported relatively low OOP costs and financial burden in the first 6 months post-diagnosis. Together with clinical outcomes, clinicians can use this up to date evidence on costs and perceived financial burdens to assist localised prostate cancer patients and their families make informed decisions about their preferred management option.

Keywords: active surveillance, active treatment, clinical guidelines, financial burden, health economics, health services research, out‐of‐pocket costs, prostate cancer.


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