Health system costs for stage-specific breast cancer: a population-based approach.

N Mittmann,C.C Earle,C Deangelis,M.C Cheung,N.B Leighl,W.K Evans,J Rangrej,N Liu,J.S Hoch,R Saskin,S.J Seung,M Trudeau,J.M Porter,K.N Dainty

doi:10.3747/co.21.2143

Abstract

The objective of the present analysis was to determine the publicly funded health care costs associated with the care of breast cancer (bca) patients by disease stage. Incident cases of female invasive bca (2005-2009) were extracted from the Ontario Cancer Registry and linked to administrative datasets from the publicly funded system. The type and use of health care services were stratified by disease stage over the first 2 years after diagnosis. Mean costs and costs by type of clinical resource used in the care of bca patients were compared with costs for a matched control group. The attributable cost for the 2-year time horizon was determined in 2008 Canadian dollars. This cohort study involved 39,655 patients with bca and 190,520 control subjects. The average age in those groups was 61.1 and 60.9 years respectively. Most bca patients were classified as either stage i (34.4%) or stage ii (31.8%). Of the bca cohort, 8% died within the first 2 years after diagnosis. The overall mean cost per bca case from a public payer perspective in the first 2 years after diagnosis was $41,686. Over the 2-year time horizon, the mean cost increased by stage: i, $29,938; ii, $46,893; iii, $65,369; and iv, $66,627. The attributable cost of bca was $31,732. Cost drivers were cancer clinic visits, physician billings, and hospitalizations. Costs of care increased by stage of bca. Cost drivers were cancer clinic visits, physician billings, and hospitalizations. These data will assist planning and decision-making for the use of limited health care resources.

Highlights

All permanent residents of the province of Ontario are covered by a publicly funded health care system
Over the 2-year time horizon, the mean cost increased by stage: i, $29,938; ii, $46,893; iii, $65,369; and iv, $66,627
The system groups patients who might not be clinically similar, but who are expected to place a similar burden on the health care system, into quintiles of predicted health resource utilization

Summary

Introduction

All permanent residents of the province of Ontario (a population of 13.2 million) are covered by a publicly funded health care system. The provincial government authority collects data about those services and the service providers. These population-level data provide researchers with a unique opportunity to analyze the types of health services delivered within the system. Breast cancer (bca) is a leading cause of morbidity and mortality in Canadian women[1] and has a significant financial impact. Because health care management for bca occurs across acute care, institutional care, and community settings, significant care and cost is assumed by the public health care system. Very few publications have determined bca lifetime costs in Canada; the reported range is $309–$454 million[3,4]

Methods

Results

Discussion

Conclusion