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Direct Medical Costs, Productivity Loss Costs and Out-Of-Pocket Expenditures in Women with Breast Cancer in Latin America and the Caribbean: A Systematic Review

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Abstract

Objective

Our objective was to conduct a systematic review of the literature to identify, categorise, assess, and synthesise the healthcare costs of patients with breast cancer (BC) and their relatives in Latin America and the Caribbean (LAC).

Methods

In December 2020, we searched for published data in PubMed, LILACS, EMBASE, and other sources, including the grey literature. Studies were eligible if they were conducted in LAC and reported the direct medical costs, productivity loss costs, out-of-pocket expenditure, and other costs to patients with BC and their relatives. No restrictions were imposed on the type of BC population (metastatic BC or human epidermal growth factor receptor 2-positive/negative BC, among others). We summarised the characteristics and methodological approach of each study and the healthcare costs by cancer stage. We also developed and applied an original ad hoc instrument to assess the quality of the cost estimation studies.

Results

We identified 2725 references and 63 included studies. In total, 79.3% of the studies solely reported direct medical costs and five solely reported costs to patients and their relatives. Only 14.3% of the studies were classified as of high quality. The pooled weighted average direct medical cost per patient-year (year 2020 international dollars [I$]) by BC stage was I$13,179 for stage I, I$15,556 for stage II, I$23,444 for stage III, and I$28,910 for stage IV.

Conclusion

This review provides the first synthesis of BC costs in LAC. Our findings show few high-quality costing studies in BC and a gap in the literature measuring costs to patients and their relatives. The high costs associated with the advanced stages of BC call into question the affordability of treatments and their accessibility for patients.

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Acknowledgements

The authors acknowledge the suggestions and comments made by the editor-in-chief and two anonymous reviewers to a previous version of the article. The authors also thank Daniel Comandé for his contributions to search strategies.

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Authors and Affiliations

  1. Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina

    Alfredo Palacios, Carlos Rojas-Roque, Lucas González, Ariel Bardach, Agustín Ciapponi, Claudia Peckaitis, Andres Pichon-Riviere & Federico Augustovski

  2. Facultad de Ciencias Económicas, Universidad de Buenos Aires, Buenos Aires, Argentina

    Alfredo Palacios

  3. Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina

    Ariel Bardach, Agustín Ciapponi, Andres Pichon-Riviere & Federico Augustovski

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  1. Alfredo Palacios
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  2. Carlos Rojas-Roque
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  3. Lucas González
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  8. Federico Augustovski
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Correspondence to Alfredo Palacios.

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Funding

This study was funded with an independent research grant from Roche Argentina (Grant number: RBRVZ208-19F).

Conflict of interest

Alfredo Palacios, Carlos Rojas-Roque, Lucas González, Ariel Bardach, Agustín Ciapponi, Claudia Peckaitis, Andres Pichon-Riviere, and Federico Augustovski have no conflicts of interest that are directly relevant to the content of this article.

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The data that support the findings of this study are available in this article and in the ESM.

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Not applicable.

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Not applicable.

Author contributions

Concept and design: AP. Formal analysis: AP, CR-R, LG, and CP. Supervision: AB, AC, AP-R, FA. Review, interpretation and discussion of the results: AP, CR-R, AB, AC, CP, AP-R, FA. Writing original draft: AP and CR-R. Writing, review and editing: AP, CR-R, LG, AB, AC, AP-R, FA.

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Palacios, A., Rojas-Roque, C., González, L. et al. Direct Medical Costs, Productivity Loss Costs and Out-Of-Pocket Expenditures in Women with Breast Cancer in Latin America and the Caribbean: A Systematic Review. PharmacoEconomics 39, 485–502 (2021). https://doi.org/10.1007/s40273-021-01014-9

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