Reducing time to treatment and patient costs with breast cancer: the impact of patient visits

Abstract

Background The purpose of this study was to evaluate the impact of processes aimed at reducing time to treatment initiation (TTI) on minimizing the days spent to complete pretreatment visits and the associated costs for patients with nonmetastatic breast cancer. Methods System‐wide initiatives were implemented in 2014 to minimize TTI, by incorporating multiple strategies (eg, creation of teams, patient liaisons, process mapping) and enhanced communication to increase coordinated visits. Average number of days spent to complete visits, TTI, and associated patient costs including driving expenses, parking, food, childcare, and lost wages were calculated and compared between the years 2015 and 2018. Results In 2015, the median TTI was 43.5 days and the average number of separate days spent to attend multidisciplinary visits prior to first treatment was 1.86. These were reduced to 29 days and 1.52 visits, respectively, in 2018 (p < 0.0001 for both). When evaluating treatment visits by surgical procedure, the average number of visits was reduced regardless of surgical procedure. The average number of visits was highest for patients undergoing mastectomy with reconstruction (2.34 in 2015, reduced to 1.65 in 2018, p < 0.0001). A single visit to complete treatment planning was associated with patient costs of $249 as compared with multiple trips costing $491 for 2 visits and up to $1,226 for 5 visits. Conclusions In breast cancer patients, implementing processes to reduce time to treatment was associated with fewer visits required prior to treatment initiation, resulting in lower patient costs.

Direct and Indirect Costs of Breast Cancer and Associated Implications: A Systematic Review

“…Of our 53 included studies, 15 (28%) reported person-level procedure costs [ 20 , 27 , 28 , 32 , 34 , 35 , 46 , 47 , 49 , 51 , 60 , 63 , 64 , 69 , 71 ]; 19 (36%) reported person-level costs over a 1-year time horizon [ 19 , 23 , 25 , 26 , 29 , 33 , 38 – 40 , 43 , 45 , 48 , 50 , 52 , 56 – 59 , 65 ]. As such, the costs from 34 (64%) studies per person for procedures and then over a 1-year time frame are presented in Table 3 and 4 , respectively, with the other included studies’ costs presented in Supplementary Excel Sheet 1.…”

“…Nine (17%) studies reported indirect costs [ 34 , 43 , 54 – 57 , 59 – 61 ]. Productivity loss is a key indirect cost for consideration, often estimated via the human capital approach, i.e., take the patient’s perspective and count any hour not worked as an hour lost, or the friction cost approach, i.e., take the employer’s perspective and only count lost hours not worked until another employee takes over the patient’s work [ 72 ].…”

“…Thirty-six (68%) of our included studies reported costs for early-stage cancer [ 19 , 20 , 22 , 24 – 27 , 29 – 31 , 34 – 40 , 44 – 48 , 53 – 58 , 60 – 62 , 65 – 67 , 70 , 71 ]; 17 (32%) included metastatic cancer [ 20 – 23 , 25 , 27 , 30 , 33 , 36 , 38 – 40 , 50 , 53 , 60 , 68 , 70 ]; 12 (23%) included both early and metastatic cancer [ 20 , 22 , 25 , 27 , 30 , 36 , 38 – 40 , 53 , 60 , 70 ]; for 12 (23%), the cancer stage was not reported [ 28 , 32 , 41 – 43 , 49 , 51 , 52 , 59 , 63 , 64 , 69 ]. Generally, across our included studies, metastatic breast cancer was associated with higher costs than earlier stage cancer (see Figs.…”

Perception of healthcare system delays and referral pathways for breast cancer care in Mexico: a PhysiciansÓ? survey

“…In accordance with previous studies in Mexico and Latin America, lack of infrastructure, insufficient human resources, and saturated health services were identified as major barriers to care [21][22][23] . Identifying these barriers has allowed the development of different strategies aimed at reducing delays in care 16,17,[24][25][26][27][28][29][30][31][32] . Among these initiatives, we highlight the development of national guidelines, the creation of rapid reference pathways for patients with symptoms suggestive of BC, the implementation of patient navigation programs, and the adoption of telemedicine 16,17,[24][25][26][27][28][29][30][31][32] .…”

“…Identifying these barriers has allowed the development of different strategies aimed at reducing delays in care 16,17,[24][25][26][27][28][29][30][31][32] . Among these initiatives, we highlight the development of national guidelines, the creation of rapid reference pathways for patients with symptoms suggestive of BC, the implementation of patient navigation programs, and the adoption of telemedicine 16,17,[24][25][26][27][28][29][30][31][32] . Particularly in Mexico, the Alerta Rosa program was created as a strategy to improve patient navigation and prioritization 27,28 .…”