Direct medical and non-medical costs of a one-year care pathway for early operable breast cancer: Results of a French multicenter prospective study

Abstract

Introduction The organization of health care for breast cancer (BC) constitutes a public health challenge to ensure quality of care, while also controlling expenditure. Few studies have assessed the global care pathway of early BC patients, including a description of direct medical costs and their determinants. The aims of this multicenter prospective study were to describe care pathways of BC patients in a geographic territory and to calculate the global direct costs of early stage BC during the first year following diagnosis. Methods OPTISOINS01 was a multicenter, prospective, observational study including early BC patients from diagnosis to one-year follow-up. Direct medical costs (in-hospital and out-of-hospital costs, supportive care costs) and direct non-medical costs (transportation and sick leave costs) were calculated by using a cost-of-illness analysis based on a bottom-up approach. Resources consumed were recorded in situ for each patient, using a prospective direct observation method. Results Data from 604 patients were analyzed. Median direct medical costs of 1 year of management after diagnosis in operable BC patients were €12,250. Factors independently associated with higher direct medical costs were: diagnosis on the basis of clinical signs, invasive cancer, lymph node involvement and conventional hospitalization for surgery. Median sick leave costs were €8,841 per patient and per year. Chemotherapy was an independent determinant of sick leave costs (€3,687/patient/year without chemotherapy versus €10,706 with chemotherapy). Forty percent (n = 242) of patients declared additional personal expenditure of €614/patient/year. No drivers of these costs were identified. Conclusion Initial stage of disease and the treatments administered were the main drivers of direct medical costs. Direct non-medical costs essentially consisted of sick leave costs, accounting for one-half of direct medical costs for working patients. Out-of-pocket expenditure had a limited impact on the household.

Cost-effectiveness and Quality of Specialized and Routine Care in a German Cohort of Patients with Chronic Pruritus

“…Direct medical costs include all monetary services that are provided in the context of diagnosis and treatment of a disease (inpatient and outpatient costs including medical consultations, services, medication, etc.) ( 15 ). These costs were assessed according to G-DRG ( 16 ) and the German system for reimbursement of outpatient care (“EBM – Einheitlicher Bewertungsmaßstab ”, Uniform Value Scale, quarter 1/2017, respectively, GOÄ, “ Gebührenordnung für Ärzte ”, fees for physicians, 1 January 2002) guidelines as well as to the valid reimbursement medication price in the German Drug Directory (as referenced in the “ LauerTaxe ”) (reference: LAUER-TAXE ® - Apotheke - Produkte - cgm.com).…”

“…Direct non-medical costs occur as a by-product of the use of medical resources (e.g. costs for transportation to the physician, costs for skin care, special food or clothing, family care costs) ( 15 ). In order to record these as precisely as possible, patients were asked to keep receipts or bank statements and to bring them to the personal interview.…”

Compliance to genomic test recommendations to guide adjuvant chemotherapy decision‐making in the case of hormone receptor‐positive, human epidermal growth factor receptor 2‐negative breast cancer, in real‐life settings

“…To identify a candidate population for testing outside current French recommendations, we calculated a ratio defined as the number of tests required to avoid chemotherapy (according to test results) for one patient, and according to patient and cancer characteristics. We then conducted cost‐saving analysis using medical cost data over a one‐year period from diagnosis from a previous study 11 . Direct medical (medical consultation, treatments, hospitalization, imaging…) and non‐medical costs (sick leave, transportation…) were calculated based on French national health insurance fund schedules.…”

“…We then conducted cost‐saving analysis using medical cost data over a one‐year period from diagnosis from a previous study. 11 Direct medical (medical consultation, treatments, hospitalization, imaging…) and non‐medical costs (sick leave, transportation…) were calculated based on French national health insurance fund schedules. We assessed an additional cost of €9737 in the case of adjuvant chemotherapy.…”

Determination of a cut-off COmprehensive Score for financial Toxicity (COST) for identifying cost-related treatment nonadherence and impaired health-related quality of life among Chinese patients with cancer

“…Even after completing treatment, patients continue to face high direct medical costs related to follow-up care, ongoing medications, and surveillance testing. Direct non-medical costs, such as specialised dietary supplements, transportation, accommodation, and informal nursing, also can quickly accumulate and thus pose significant challenges for patients with limited financial resources [ 3 , 5 , 6 ]. Additionally, indirect costs related to the impact of the illness on patients’ ability to earn income and caregivers’ lost productivity further compound the economic burden associated with cancer [ 3 , 4 , 6 ].…”