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

Abstract

IntroductionThe organization of health care for breast (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.\n\nMethodsOPTISOINS01 was a multicenter, prospective, observational study including early BC patients from diagnosis to one-year follow-up. Direct medical costs (in-hospital and out-ofhospital 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.\n\nResultsData from 604 patients were analyzed. Median direct medical costs of 1 year of management after diagnosis in operable BC patients were {euro}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 {euro}8,841 per patient and per year. Chemotherapy was an independent determinant of sick leave costs ({euro}3,687/patient/year without chemotherapy versus {euro}10,706 with chemotherapy). Forty percent (n=242) of patients declared additional personal expenditure of {euro}614/patient/year. No drivers of these costs were identified.\n\nConclusionInitial 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.