Economics, quality of life and breast cancer outcomes – is a balance possible?

Abstract

SUMMARY Breast cancer is a leading cause of cancer death and a major source of healthcare expenditure in most countries in the developed world. Recent therapeutic advances have led to widespread use of breast-conserving therapy and to increased use of systemic adjuvant therapy. New hormonal, chemotherapeutic and supportive care agents have been introduced in the metastatic setting. Collectively, these advances have led to increased survival and, arguably, enhanced quality of life. However, incremental survival benefits have often been small and psychosocial/quality of life improvements difficult to quantify. In contrast, both incremental and total costs have usually been large and readily apparent. Available resources have often been inadequate to provide what is perceived to be optimal care to all patients, and it has been necessary to make trade-offs between survival, psychosocial status/quality of life and costs. Approaches to incorporation of quality of life into economic evaluations are reviewed and limitations discussed. Published economic evaluations in breast cancer are summarized. Potential approaches to balancing costs and benefits, as they apply to breast cancer, are outlined.