Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing

Abstract

Background: Breast cancer (BC) treatment is rapidly evolving with new and costly therapeutics. Existing costing models have a limited ability to capture current treatment costs. We used an Activity-Based Costing (ABC) method to determine a per-case cost for BC treatment by stage and molecular subtype. Methods: ABC was used to proportionally integrate multidisciplinary evidence-based patient and provider treatment options for BC, yielding a per-case cost for the total duration of treatment by stage and molecular subtype. Diagnostic imaging, pathology, surgery, radiation therapy, systemic therapy, inpatient, emergency, home care and palliative care costs were included. Results: BC treatment costs were higher than noted in previous studies and varied widely by molecular subtype. Cost increased exponentially with the stage of disease. The per-case cost for treatment (2023C$) for DCIS was C$ 14,505, and the mean costs for all subtypes were C$ 39,263, C$ 76,446, C$ 97,668 and C$ 370,398 for stage I, II, III and IV BC, respectively. Stage IV costs were as high as C$ 516,415 per case. When weighted by the proportion of molecular subtype in the population, case costs were C$ 31,749, C$ 66,758, C$ 111,368 and C$ 289,598 for stage I, II, III and IV BC, respectively. The magnitude of cost differential was up to 10.9 times for stage IV compared to stage I, 4.4 times for stage III compared to stage I and 35.6 times for stage IV compared to DCIS. Conclusion: The cost of BC treatment is rapidly escalating with novel therapies and increasing survival, resulting in an exponential increase in treatment costs for later-stage disease. We provide real-time, case-based costing for BC treatment which will allow for the assessment of health system economic impacts and an accurate understanding of the cost-effectiveness of screening.

Effect of Breast Screening Regimen on Breast Cancer Outcomes: A Modeling Study

“…Of course, there is also an increase in the total number of screening examinations that must be performed. This has implication on costs and the resources required to conduct the screening; however, as suggested in the recent work of Wilkinson et al, a substantial fraction of these costs could be offset by a reduction of the cost of treating Stage 3 and 4 cancers through earlier detection [20].…”

“…The model also has the provision of calculating costs of screening and therapy for cost-effectiveness studies; however, as indicated by Wilkinson et al, the treatment costs currently used in the model are now out of date and require revision to reflect current practice [20].…”

Medical cost of breast cancer services in Serbia between 2010 and 2019: national data report

“…In 52.5% of cases, the malignant disease in Serbia is diagnosed in an advanced stage (III-b or IV) with regional and distant metastases ( 18 ). Since the costs of breast cancer treatment is progressively increasing with new expensive therapy options and better progression free survivals and overall survivals, there is an exponential increase in treatment costs, especially for later stages of illness ( 19 ).…”

Use of microsimulation modeling for research in breast cancer screening

“…In recent work our colleagues have assembled a table of current costs for breast cancer screening and for treatment of breast cancers of each subtype and stage. 10 We have incorporated these data into user scenarios for the OncoSim Breast model. It has been demonstrated previously that both the cost of screening a population and the benefit (lives saved or years of life gained) will increase when screening begins at an earlier age, ends at an older age and is conducted more frequently (e.g, annually rather than bi-or triennially).…”