The total hospital and community UK costs of managing patients with relapsed breast cancer

Abstract

The complete hospital and community records of 77 women were randomly selected from 232 women who had relapsed breast cancer between 2000 and 2005. Scrutiny of all management activities revealed a total cost of d1 939 329 (mean per patient of d25 186, 95% CI d13 705 -d33 821). The median survival from time of relapse was 40.07 months and the median total cost per patient was d31 402.62. Including the community cost of a relapse provides a more realistic figure for future cost-effectiveness analysis of adjuvant breast cancer therapies. et al, 2006). To decide whether the benefits are cost-effective, budget holders require an accurate knowledge of how much it costs to treat patients with relapse. Most earlier estimates have used predictive modelling or interviews with clinicians (Mansel et al, 2007). A UK trial, now 6 years old, estimated hospital costs of relapsed breast cancer by sending questionnaires to UK oncologists and produced a figure of d12 500 per patient (Remak and Brazil, 2004). A study from Edinburgh, collecting hospital data from node-positive women, gave a figure of d13 533 for locoregional relapse and d13 193 for distant relapse (Karnon et al, 2007). We report the first analysis of the total hospital and community cost of managing patients with relapsed breast cancer from a typical UK breast cancer practice. METHODSThe Bedford Breast Cancer database identified 232 women who had relapsed between March 2000 and March 2005 with locoregional or distant disease. The identification codes were placed in separate sealed envelopes and one-third (77) randomly selected for data collection until their death or the predetermined end of the study in January 2007. The average age of the cohort was 62.3 years (33 -95) and 44% were originally node positive; 67% postmenopausal, 48% stage 1 (T1), 33% T2, 16% T3 -4; 55% oestrogen receptor (ER) þ ve , 25% ER Àve (25% unknown) and 21% overexpressed human epithelial growth factor receptor (HER)2 (17% unknown). The demographics of the entire group and selected cohort were similar, indicating that the randomisation process was balanced. The specific cancer-related activities were derived from written and electronic hospital records (Table 1). For each patient, a member of the research team visited all GP practices, hospices and community offices to collect all the relapse-related management and drug activities, which ensured there was no missing data. Once complete, the data set was locked and analysed in liaison with the Health Economics Department of Cranfield University. The predetermined subgroups chosen were menopausal status, ER status and HER2 expression, as these influence drug strategies on relapse. Whether patients suffered local or distant relapse was not included, as an earlier analysis did not demonstrate a cost difference (Karnon et al, 2007).The NHS tariffs for outpatient visits, procedures, nights in hospital and investigations were derived from the existing NHS Trust Reference Cost Index 2004 (DoH, 2004). Radiotherapy was costed per fraction taken from t...

Gene expression profiling and expanded immunohistochemistry tests to guide the use of adjuvant chemotherapy in breast cancer management: a systematic review and cost-effectiveness analysis

“…156 For patients experiencing distant recurrence, the median survival was assumed to be 3.3 years. 157 …”

“…All patients within each OncotypeDX risk category were assumed to have the average risk of recurrence for that group. The probability of dying from distant metastasis was derived from Thomas et al, 157 assuming a median life expectancy of 3.3 years. Again, this was assumed to be the same for all risk groups.…”

Cost analysis for cancer subgroups

“…We thank Thomas et al (2009) for their thorough collection and presentation of resource use and costs for breast cancer relapse. This represents an excellent summary of the costs of advanced breast cancer to the NHS.…”

“…This will result in very different treatment pathways with differences in resource use and costs and a consequent influence on cost-effectiveness results. Thomas et al (2009) present their cost analysis with a view to future economic evaluation of new targeted therapies for early breast cancer. In addition to calculating a monthly cost per patient from relapse, it would be useful to consider costs, which arise prior to relapse.…”

“…Standards must be adopted at a national level for independently collecting subgroup data as malignant diseases become further divided by gene expression profiling with individualised treatment options. Cost analyses such as Thomas et al (2009) have provided, represent a first step in this direction and are invaluable in providing evidence for increasingly difficult decisions.…”