Journal Article

Direct medical and non-medical costs of a one-year care pathway for early operable breast cancer: Results of a French multicenter prospective study

Asselain, Bernard, Nguyen, Thuy, Héquet, Delphine, Rouzier, Roman, Berseneff, Helene, Alves, Karine, Soilly, Anne-Laure, Combes, Aline, Huchon, Cyrille, Baffert, Sandrine, Trichot, Caroline

2019

Overview

The organization of health care for breast cancer (BC) constitutes a public health challenge to ensure quality of care, while also controlling expenditure. Few studies have assessed the global care pathway of early BC patients, including a description of direct medical costs and their determinants. The aims of this multicenter prospective study were to describe care pathways of BC patients in a geographic territory and to calculate the global direct costs of early stage BC during the first year following diagnosis. OPTISOINS01 was a multicenter, prospective, observational study including early BC patients from diagnosis to one-year follow-up. Direct medical costs (in-hospital and out-of-hospital costs, supportive care costs) and direct non-medical costs (transportation and sick leave costs) were calculated by using a cost-of-illness analysis based on a bottom-up approach. Resources consumed were recorded in situ for each patient, using a prospective direct observation method. Data from 604 patients were analyzed. Median direct medical costs of 1 year of management after diagnosis in operable BC patients were €12,250. Factors independently associated with higher direct medical costs were: diagnosis on the basis of clinical signs, invasive cancer, lymph node involvement and conventional hospitalization for surgery. Median sick leave costs were €8,841 per patient and per year. Chemotherapy was an independent determinant of sick leave costs (€3,687/patient/year without chemotherapy versus €10,706 with chemotherapy). Forty percent (n = 242) of patients declared additional personal expenditure of €614/patient/year. No drivers of these costs were identified. Initial stage of disease and the treatments administered were the main drivers of direct medical costs. Direct non-medical costs essentially consisted of sick leave costs, accounting for one-half of direct medical costs for working patients. Out-of-pocket expenditure had a limited impact on the household.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Accounting / Adult / Aged / Aged, 80 and over / Analysis / Breast cancer / Breast Neoplasms - economics / Breast Neoplasms - therapy / Cancer research / Cancer therapies / Care and treatment / Chemotherapy / Control / Cost analysis / Cost of Illness / Costs / Critical Pathways - economics / Diagnosis / Dissection / Employee benefits / Female / France / Gynecology / Health Care Costs / Health care expenditures / Health economics / Hospital Costs / Hospitals / Humans / Influence / Innovations / Invasiveness / Lymph nodes / Mathematical analysis / Medical care / Medical care quality / Medical diagnosis / Medical economics / Medical treatment / Medicine and Health Sciences / Middle Aged / National Health Programs / Observational studies / Out-of-pocket expenses / Outpatient care facilities / Patient care / Patients / Population / Prospective Studies / Public health / Quality management / Social Sciences / Studies / Surgery / Territory / Womens health