Abstract
IntroductionDelays in cancer diagnosis arose from the commencement of non-pharmaceutical interventions (NPI) introduced in the UK in March 2020 in response to the COVID-19 pandemic. Our earlier work predicted this will lead to approximately 3620 avoidable deaths for four major tumour types (breast, bowel, lung, and oesophageal cancer) in the next 5 years. Here, using national population-based modelling, we estimate the health and economic losses resulting from these avoidable cancer deaths. We also compare these with the impact of an equivalent number of COVID-19 deaths to understand the welfare consequences of the different health conditions. MethodsWe estimate health losses using quality-adjusted life years (QALYs) and lost economic productivity using the human capital (HC) approach. The analysis uses linked English National Health Service (NHS) cancer registration and hospital administrative datasets for patients aged 15–84 years, diagnosed with breast, colorectal, and oesophageal cancer between 1st Jan to 31st Dec 2010, with follow-up data until 31st Dec 2014, and diagnosed with lung cancer between 1st Jan to 31st Dec 31 2012, with follow-up data until 31st Dec 2015. Productivity losses are based on the estimation of excess additional deaths due to cancer at 1, 3 and 5 years for the four cancer types, which were derived from a previous analysis using this dataset. A total of 500 random samples drawn from the total number of COVID-19 deaths reported by the Office for National Statistics, stratified by gender, were used to estimate productivity losses for an equivalent number of deaths (n = 3620) due to SARS-CoV-2 infection. ResultsWe collected data for 32,583 patients with breast cancer, 24,975 with colorectal cancer, 6744 with oesophageal cancer, and 29,305 with lung cancer. We estimate that across the four site-specific cancers combined in England alone, additional excess cancer deaths would amount to a loss of 32,700 QALYs (95% CI 31,300-34,100) and productivity losses of £103.8million GBP (73.2–132.2) in the next five years. For breast cancer, we estimate a loss of 4100 QALYS (3900–4400) and productivity losses of £23.2 m (18.2–28.6); for colorectal cancer, 15,000 QALYS (14,100–16,000) lost and productivity losses of £35.7 m (22.4–48.7); for lung cancer 10,900 QALYS (9,900–11,700) lost and productivity losses of £38.3 m (14.0–59.9) for lung cancer; and for oesophageal cancer, 2700 QALYS (2300–3,100) lost and productivity losses of £6.6 m (–6 to –17.6). In comparison, the equivalent number of COVID-19 deaths caused approximately 21,450 QALYs lost, as well as productivity losses amounting to £76.4 m (73.5–79.2). ConclusionPremature cancer deaths resulting from diagnostic delays during the first wave of the COVID-19 pandemic in the UK will result in significant economic losses. On a per-capita basis, this impact is, in fact, greater than that of deaths directly attributable to COVID-19. These results emphasise the importance of robust evaluation of the trade-offs of the wider health, welfare and economic effects of NPI to support both resource allocation and the prioritisation of time-critical health services directly impacted in a pandemic, such as cancer care.
Highlights
Delays in cancer diagnosis arose from the commencement of nonpharmaceutical interventions (NPI) introduced in the UK in March 2020 in response to the COVID-19 pandemic
We model the economic impacts of diagnostic delay during the COVID-19 pandemic using excess mortality estimates derived from the study by Maringe et al, [14] published in July 2020, which predicted that for four major tumour types, delays in diagnosis due to NPI during the first pandemic wave would lead to approximately 3620 avoidable deaths and 60,000 life years lost within 5 years of diagnosis
Patients were aged 15e84 years and the mean age at diagnosis was 60$5 years (Standard Deviation (SD) 12$6) for breast cancer, 68$5 years (10$7) for colorectal cancer, 68$5 years (10$3) for oesophageal cancer, and 69$8 years (9$3) for lung cancer. 10,441 (41$8%) of 24,975 patients diagnosed with colorectal cancer, 13,211 (45$1%) of 29,305 diagnosed with lung cancer, and 1894 (28$1%) of 6744 diagnosed with oesophageal cancer were women
Summary
Delays in cancer diagnosis arose from the commencement of nonpharmaceutical interventions (NPI) introduced in the UK in March 2020 in response to the COVID-19 pandemic. In the UK, following the first wave of the pandemic, up to 3 million men and women did not receive screening investigations due to suspension of these services, fewer patients were referred with suspected cancers [1], and 3.2 million fewer investigations (e.g., colonoscopy, cystoscopy, gastroscopy, CT scans, MRI between March and July 2020) were performed due to cancellation or deferral [2,3] This decrease in referrals and diagnostic investigation implies an eventual later diagnosis with more advanced-stage cancer, which will have a direct impact on long term prognosis [4,5]. These delays in the cancer pathway will undoubtedly have consequences on premature mortality [11]
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