Economic burden of cancer care in Lebanon's privately insured population: a seven-year retrospective cohort analysis (2018-2024).

BACKGROUND: Cancer imposes a growing economic burden on health systems globally, yet longitudinal, population-level data on cancer care costs within private insurance remain scarce in low- and middle-income countries. Lebanon's private insurance sector, administered through third-party administrators (TPAs), covers a substantial share of the economically active population, yet no published study has characterized its cancer-related economic burden, including during the country's economic contraction since 2019. METHODS: A retrospective cohort analysis used event-level insurance claims from a leading Lebanese TPA for 2018-2024. Claims carrying an ICD-10 cancer diagnosis code (C or D series, excluding benign neoplasms D10-D36) were processed through a standardized pipeline from event to patient level. Analyses covered demographics, cancer type distribution, treatment and service utilization, cost trends, per-member-per-year (PMPY) expenditure, and a high-cost cohort (HCC) defined as USD 100,000 or more in cumulative costs within any rolling 365-day window. RESULTS: The cohort comprised 16,617 unique cancer patients generating 157,550 claims and USD 239.9 million in total expenditure over seven years. Females accounted for 53.7% of patients; breast cancer was the most prevalent diagnosis (19.7%), in the predominant 40-64-year age group (50.2%). Surgery was the most common treatment modality (29.3%), followed by cancer medicines (24.2%) and radiotherapy (14.9%), yet cancer medicines were the largest cost category (37.8% of spend). Annual expenditure rose from USD 35.7 million (2018) to USD 48.9 million (2024), with a transient compression in 2022. A high-cost cohort of 285 patients (1.7%) accounted for USD 55.1 million (23.0% of spend), led by lung cancer (19.7%). Cancer patient rates rose 24.5% (1,015 to 1,263 per 100,000), and per-member cost rose steeply with age, reaching USD 606 PMPY among patients aged 65+ in 2024 versus USD 15-169 in younger groups; overall PMPY reached USD 111.50, recovering from the 2022 trough. CONCLUSIONS: This study provides the first longitudinal, claims-based characterization of cancer care's economic burden in Lebanon's privately insured population. Costs are concentrated in a small, identifiable high-cost subgroup, cancer medicines dominate expenditure despite surgery leading by patient volume, and the per-member burden is rising - an actuarial foundation for designing sustainable, oncology-specific benefit structures.