Lung Cancer's Price Tag: Regional Disparities and Temporal Trends in Hospitalization Costs in Brazil Over the Past Two Decades.

PURPOSE: Lung cancer (LC) remains a leading cause of cancer mortality worldwide. In Brazil, budgetary constraints in the public health system may influence access to oncologic care. This study analyzes temporal trends in average costs per hospitalization and length of stay (LOS) for LC across Brazil between 2001 and 2024.

METHODS

This national ecologic time-series study used data from the Hospital Information System of the Unified Health System (SIH/SUS) for LC (International Classification of Diseases, 10th Revision: C34). Adults 20 years and older were stratified by sex, age, and five administrative regions. Costs were adjusted for inflation using Broad Consumer Price Index and converted to $2000 US dollars (USD). Linear regression was the primary approach, and quadratic models were applied when adjusted R2 and visual inspection indicated poor linear fit. Spearman's rho (ρ) assessed correlation between LOS and daily costs (Stata 15.0; α = .05).

RESULTS

A total of 457,152 LC hospitalizations were recorded (total expenditure: $134,999,677.20 USD). Decreasing national trends were observed for average cost per admission (men: β = -5.19; women: β = -4.65; P < .001) and LOS (men: β = -.192; women: β = -.195; P < .001). Costs were consistently higher among women, despite more hospitalizations among men. The 20- to 34-year age group showed the highest average costs; elderly patients had the lowest. The South presented the highest costs, and the North, the lowest. A negative correlation between LOS and daily costs was observed across all regions (P < .001).

CONCLUSION

Average LC hospitalization costs and LOS showed declining trends. Subgroup analyses revealed regional, age-, and sex-related differences, suggesting persistent inequalities in SUS resource distribution and the need for evidence-based strategies for more equitable resource allocation.