Observational Study Evaluating the Economic Impact of Breakthrough Pain in Cancer Patients in Clinical Practice in Spain: The IMDI Study

Abstract

IntroductionBreakthrough pain (BTP) has great repercussions on the quality of life, and on the use of health resources. The scope of BTP costs in cancer patients is unknown. The purpose of this study was to evaluate the economic cost of BTP in patients with cancer and the relationship with their quality of life.MethodsA 1-month observational prospective cost-of-illness study was designed. The patients recorded the consumption of health resources and drugs related to BTP in a diary. The current symptoms in Edmonton Symptoms Assessment Scale (ESAS) and their quality of life (EORTC QLQ-C30, version 3) were assessed. The direct medical and non-medical costs fixed and variable and the indirect costs of the patient and the caregivers were evaluated. Factors related to cost and quality of life were identified using linear generalized models (LGM) type gamma and logistic link. Participants were oncologic patients with BTP, older than 18 years, with controlled basal pain.ResultsEight Spanish pain units, eight palliative care units, and one oncology department included 152 patients. One hundred patients (65.8%) were male and the mean age was 66.8 years (95% CI 64.8–68.8). The total cost per patient was 2941.60 euros per month: 88% direct medical costs, 5% non-medical direct costs, and 7% indirect costs due to lost productivity. A better score in EORTC QLQ-30 quality of life was associated with a reduction in overall costs.ConclusionsThe study showed the results of the first real-life prospective study evaluating the cost of illness of BTP in cancer patients demonstrating that the presence of breakthrough pain in a cancer patient causes a very significant increase in healthcare costs.FundingKyowa Kirin Farmacéutica, S.L.U.

Wage losses among spouses of women with nonmetastatic breast cancer

“…Previous studies addressing the extent of spouse wage losses differed in the types of cancer considered (eg, any type, lung cancer, and colorectal cancer), included mixed stages of disease or focused only on advanced disease, and were conducted in countries with different insurance and health care systems (eg, Canada, the United States, China, and Norway) . In these studies, wage loss estimates were calculated for different time periods (range, 1 day of work to 8 years after diagnosis) and with various data sources (self‐reported data and administrative databases) and methods of valuing time lost from work.…”

“…Previous studies addressing the extent of spouse wage losses differed in the types of cancer considered (eg, any type, lung cancer, and colorectal cancer), included mixed stages of disease or focused only on advanced disease, and were conducted in countries with different Cancer March 1, 2020 insurance and health care systems (eg, Canada, the United States, China, and Norway). [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] In these studies, wage loss estimates were calculated for different time periods (range, 1 day of work to 8 years after diagnosis) and with various data sources (self-reported data and administrative databases) and methods of valuing time lost from work. In 1 case, caregiver wage losses were determined to assess the incremental loss from metastatic breast cancer versus nonmetastatic breast cancer, although whether the reason for leave was breast cancer was not documented.…”

“…3 Recent systematic 9 and scoping reviews 10 have reported that cancer negatively affects the employment of spouses of patients with cancer in terms of decreased productivity and work absences. Although a few studies have estimated how decreased productivity and work absences translate into spouses' wage losses, [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] most have focused on cancers other than breast cancer 17,18,[24][25][26] or mixed groups including breast cancer with varying disease stages 11,12,[14][15][16]23 Cancer March 1, 2020 or only advanced disease, 13,[19][20][21][22] and this makes it impossible to isolate specifically the effect of nonmetastatic breast cancer on spouse wage losses. Thus, information is needed to understand the extent to which spouses experience wage losses as a result of nonmetastatic breast cancer.…”

Assessment of symptoms, quality of life and associated costs in a one-month follow-up of cancer patients with breakthrough pain: The IMDI Study

“…The total BTP cost per patient was estimated at 2941.60 euros per month, where 88% resulted direct medical costs, 5% non-medical direct costs, and 7% indirect costs due to loss of productivity. From the multivariate analyses a better baseline EORTC QLQ-30 quality of life score, was associated with lower overall BTP costs [12].…”

“…Real-life studies about the costs of BTP in cancer patients are scarce, and no prospective ones have been conducted in real world BTP patients [9][10][11]. Obtaining information about the real costs of BTP in cancer patients was the primary objective of the main study, and cost of illness results obtained were recently published [12]. The total BTP cost per patient was estimated at 2941.60 euros per month, where 88% resulted direct medical costs, 5% non-medical direct costs, and 7% indirect costs due to loss of productivity.…”