Diagnostic and therapeutic approaches for nonmetastatic breast cancer in Canada, and their associated costs

Abstract

In an era of fiscal restraint, it is important to evaluate the resources required to diagnose and treat serious illnesses. As breast cancer is the major malignancy affecting Canadian women, Statistics Canada has analysed the resources required to manage this disease in Canada, and the associated costs. Here we report the cost of initial diagnosis and treatment of nonmetastatic breast cancer, including adjuvant therapies. Treatment algorithms for Stages I, II, and III of the disease were derived by age group (< 50 or ≥ 50 years old), principally from Canadian cancer registry data, supplemented, where necessary, by the results of surveys of Canadian oncologists. Data were obtained on breast cancer incidence by age, diagnostic work-up, stage at diagnosis, initial treatment, follow-up practice, duration of hospitalization and direct care costs. The direct health care costs associated with ‘standard’ diagnostic and therapeutic approaches were calculated for a cohort of 17 700 Canadian women diagnosed in 1995. Early stage (Stages I and II) breast cancer represented 87% of all incident cases, with 77% of cases occurring in women ≥ 50 years. Variations were noted in the rate of partial vs total mastectomy, according to stage and age group. Direct costs for diagnosis and initial treatment ranged from $8014 for Stage II women ≥ 50 years old, to $10 897 for Stage III women < 50 years old. Except for Stage III women < 50 years old, the largest expenditure was for hospitalization for surgery, followed by radiotherapy costs. Chemotherapy was the largest cost component for Stage III women < 50 years old. This report describes the cost of diagnosis and initial treatment of nonmetastatic breast cancer in Canada, assuming current practice patterns. A second report will describe the lifetime costs of treating all stages of breast cancer. These data will then be incorporated into Statistics Canada's Population Health Model (POHEM) to perform cost-effectiveness studies of new therapeutic interventions for breast cancer, such as the cost-effectiveness of day surgery, or of radiotherapy to all breast cancer patients undergoing breast surgery. © 1999 Cancer Research Campaign

The Economic Consequences of Breast Cancer Adjuvant Hormonal Treatments

“…Although there is a growing literature on the economics of cancer care, it has largely focused on the increasing proportion of global health spending accounted for by cancer care. [18][19][20][21] Little attention has been paid to the economic consequences of cancer among survivors and their families. We found that patients who were treated solely with the more expensive AI drugs were more likely to experience financial difficulties.…”

The Economic Burden of Cancers Attributable to Tobacco Smoking, Excess Weight, Alcohol Use, and Physical Inactivity in Canada

“…In the early 1990s, Statistics Canada developed the Population Health Model to "assist in the evaluation of cancer control interventions and policy decision-making" 1 , with a focus on lung 2,3 , breast [4][5][6] , and colorectal cancers 7 . More recently, the Canadian Partnership Against Cancer developed the Cancer Risk Management Model to "gain insight into the cost/benefit of cancer control strategies to help guide and strengthen decision-making" 8 , with a focus on lung 9 and colorectal cancers 10 .…”

Economic burden associated with breast cancer recurrence

“…The greatest economic burden was observed among patients who had distant recurrences, adding to previous findings that patients with advanced breast cancer at diagnosis incur significantly more healthcare charges compared with patients who are diagnosed at an earlier stage. [3][4][5][6][7] Furthermore, for all recurrence types (i.e., locoregional, contralateral breast, and distant recurrences), postrecurrence charges for care were significantly greater than prerecurrence charges. These results are consistent with a previous study in men with prostate cancer in which it was noted that metastatic progression and prostate-specific antigen progression were associated with significantly greater healthcare charges compared with patients who did not have disease progression.…”

“…ies that evaluated the cost of breast cancer care, [3][4][5][6][7] but none of those authors investigated the economic burden associated with disease recurrence among women with early breast cancer. This represents an important gap in current knowledge for physicians and payors alike, because such information may help to quantify the benefit of recommended new (and generally more expensive) treatments that significantly reduce the risk of breast cancer recurrence.…”