Trends in Publicly Funded Hospital Admissions and Reimbursement Associated With Non-melanoma Skin Cancer in Brazil, 2008-2023: A Nationwide Time-Series Study.

Background  Non-melanoma skin cancer is common, but its health-system burden is incompletely represented by incidence and mortality estimates because most care is delivered outside conventional inpatient settings. We assessed long-term trends and regional variation in publicly financed hospital admissions and admission-related reimbursement associated with non-melanoma skin cancer in Brazil's Unified Health System (SUS). Methods  We conducted a nationwide ecological time-series study of admission authorizations recorded in the Hospital Information System of the Brazilian Unified Health System (SIH/SUS) from 2008 to 2023. SIH/SUS records reimbursed admission episodes rather than unique patients; readmissions, transfers, and multiple admissions for the same tumor cannot be identified. Admissions with a principal diagnosis coded as ICD-10 C44 were included as an operational measure of hospital care associated with non-melanoma malignant skin neoplasms and were classified according to the place of hospitalization. Annual crude and age-standardized admission rates were calculated for Brazil and its five macro-regions; direct standardization used the age distribution of the 2022 Brazilian Census. Approved SUS reimbursement was adjusted to 2023 Brazilian reais using the national consumer price index. Temporal trends in log-transformed admission counts, rates, total reimbursement, reimbursement per admission, and mean length of stay were estimated using Prais-Winsten regression and reported as annual percentage changes (APCs) with 95% CIs. Results  Between 2008 and 2023, 535,750 admission episodes were recorded. Annual admissions increased from 13,974 to 60,075 (APC 9.44%, 95% CI 7.43 to 11.50), and the age-standardized rate increased from 10.4 to 28.0 per 100,000 population (APC 6.07%, 95% CI 4.10 to 8.07). Rates increased in the North, Southeast, South, and Central-West, whereas the Northeast showed no evidence of a temporal trend. Cumulative inflation-adjusted approved reimbursement was R$949.3 million, and annual reimbursement increased by 6.92% (95% CI 4.96 to 8.91). Reimbursement per admission decreased by 2.22% annually (95% CI -2.80 to -1.64), and mean length of stay decreased by 6.77% annually (95% CI -8.47 to -5.04). In 2023, the age-standardized rate ranged from 9.2 per 100,000 population in the North to 57.4 per 100,000 population in the South. Conclusions Publicly financed hospital admissions and total approved SUS reimbursement associated with ICD-10 C44 increased substantially in Brazil between 2008 and 2023, with marked regional variation. The increase in recorded reimbursement occurred alongside substantial growth in admission volume, despite declining reimbursement per episode and shorter recorded stays. These findings quantify the publicly financed hospital component of service use and should not be interpreted as population incidence, the number of unique patients, or total treatment costs.