Expected 10-year treatment cost of breast cancer detected within and outside a public screening program in Norway

Abstract

Background

The shift towards earlier stages of disease advancement at diagnosis when introducing mammography screening is expected to affect the treatment costs of breast cancer.

Materials and methods

We collected data on hospital resource use in Norway following a breast cancer diagnosis for the period 1 January, 2008 through 31 December, 2009 for women aged 50–69 years, diagnosed with breast cancer during the period 1 January, 1999 through 31 December, 2009. We estimated treatment costs using a function that included the probability of being at risk for receiving treatment, estimated by means of the Cox proportional hazard model.

Results

In total, 16,045 patients were included for the analyses among which 10.5 % died during the study period. The mean 10-year per-person treatment cost was €31,940 (95 % CI €31,030–32,880), and lower for cancers detected within the public screening program (€30,730) than for those detected elsewhere (€36,230). For ductal carcinoma in situ (DCIS) and cancers in stages I thru IV, treatment costs were €15,740, €23,570, €46,550, €55,230 and €60,430, respectively. Interval cancers occurring within the screening program were generally more resource demanding than both cancers detected at screening or elsewhere.

Conclusions

Ten-year treatment costs increased by increasing stage at diagnosis. Patients whose cancer was detected within the public screening program had lower treatment costs than those detected elsewhere. Interval cancers had higher costs than others.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    John, R., Ross, H.: The global economic cost of cancer. The American Cancer Society and LIVESTRONG, report (2010). Available from: http://www.cancer.org/acs/groups/content/@internationalaffairs/documents/document/acspc-026203.pdf. Accessed 20 May 2015

  2. 2.

    Christensen, K., Doblhammer, G., Rau, R., Vaupel, J.W.: Ageing populations: the challenges ahead. Lancet 374(9696), 1196–1208 (2009)

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Coleman, M.P., Forman, D., Bryant, H., Butler, J., Rachet, B., Maringe, C., et al.: Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (The International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet 377(9760), 127–138 (2011)

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Cancer Registry of Norway: cancer in Norway 2012. Cancer incidence, mortality, survival and prevalence in Norway. Oslo, Norway: Cancer Registry of Norway (2014)

  5. 5.

    Hakama, M., Elovainio, L., Kajantie, R., Louhivuori, K.: Breast cancer screening as public health policy in Finland. Br. J. Cancer 64(5), 962–964 (1997)

    Article  Google Scholar 

  6. 6.

    Campbell, J.D., Ramsey, S.D.: The costs of treating breast cancer in the US: a synthesis of published evidence. Pharmacoeconomics 27(3), 199–209 (2009)

    Article  PubMed  Google Scholar 

  7. 7.

    Baker, M.S., Kessler, L.G., Urban, N., Smucker, R.C.: Estimating the treatment costs of breast and lung cancer. Med. Care. 29(1), 40–49 (1991)

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Yabroff, K.R., Lund, J., Kepka, D., Mariotto, A.: Economic burden of cancer in the United States: estimates, projections, and future research. Cancer Epidemiol. Biomark. Prev. 20(10), 2006–2014 (2011)

    Article  Google Scholar 

  9. 9.

    Riley, G.F., Potosky, A.L., Lubitz, J.D., Kessler, L.G.: Medicare payments from diagnosis to death for elderly cancer patients by stage at diagnosis. Med. Care. 33(8), 828–841 (1995)

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    McDonough, K.L.: Breast cancer stage cost analysis in a managed care population. Based on a presentation. Am. J. Manag. Care 5(6th suppl.), 377–382 (1999)

    Google Scholar 

  11. 11.

    Kauhava, L., Immonen-Raiha, P., Parvinen, I., Helenius, H., Kaljonen, A., Rasanen, O., et al.: Lower costs of hospital treatment of breast cancer through a population-based mammography screening programme. Eur. J. Public Health 14(2), 128–133 (2004)

    Article  PubMed  Google Scholar 

  12. 12.

    Cancer Registry of Norway: special issue. Cancer screening in Norway. Oslo, Norway: Cancer Registry of Norway (2011)

  13. 13.

    Bech, M., Gyrd-Hansen, D.: Cost implications of routine mammography screening of women 50–69 years in the county of Funen Denmark. Health Policy 54(2), 125–141 (2000)

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Norum, J.: Breast cancer screening by mammography in Norway. Is it cost-effective? Ann. Oncol. 10(2), 197–203 (1999)

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Larsen, I.K., Smastuen, M., Johannesen, T.B., Langmark, F., Parkin, D.M., Bray, F., et al.: Data quality at the cancer registry of Norway: an overview of comparability, completeness, validity and timeliness. Eur. J. Cancer 45(7), 1218–1231 (2009)

    Article  PubMed  Google Scholar 

  16. 16.

    Statistics Norway: Helseutgifter, Nøkkeltall. 1997–2009 (Health care expenses, key figures. 1997–2009) (2011). https://www.ssb.no/a/kortnavn/helsesat/tab-2011-05-19-01.html. Accessed 8 Oct 2014

  17. 17.

    The Norwegian Health Directorate: innsatsstyrt finansiering 2008 (eng: activity based financing 2008). The Norwegian Health Directorate (2008)

  18. 18.

    The Norwegian Health Directorate: IS-1678. Aktivitetsdata for somatisk spesialisthelsetjeneste 2008. The Norwegian Health Directorate (2008)

  19. 19.

    Etzioni, R., Urban, N., Baker, M.: Estimating the costs attributable to a disease with application to ovarian cancer. J. Clin. Epidemiol. 49(1), 95–103 (1996)

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Efron, B., Tibshirani, R.J.: An introduction to the bootstrap. CRC Press LLC, Florida (1998)

    Google Scholar 

  21. 21.

    Kauhava, L., Immonen-Raiha, P., Parvinen, I., Holli, K., Kronqvist, P., Pylkkänen, L., et al.: Population-based mammography screening results in substantial savings in treatment costs for fatal breast cancer. Breast Cancer Res. Treat. 98(2), 143–150 (2006)

    Article  PubMed  Google Scholar 

  22. 22.

    Legorreta, A.P., Brooks, R.J., Leibowitz, A.N., Solin, L.J.: Cost of breast cancer treatment. A 4 year longitudinal study. Arch. Intern. Med. 156(19), 2197–2201 (1996)

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Zackrisson, S., Andersson, I., Manjer, J., Janzon, L.: Non-attendance in breast cancer screening is associated with unfavourable socio-economic circumstances and advanced carcinoma. Int. J. Cancer 108(5), 754–760 (2004)

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Rayson, D., Payne, J.I., Abdolell, M., Barnes, P.J., MacIntosh, R.F., Foley, T., et al.: Comparison of clinical-pathologic characteristics and outcomes of true interval and screen-detected invasive breast cancer among participants of a Canadian breast screening program: a nested case-control study. Clin. Breast Cancer 11(1), 27–32 (2011)

    Article  PubMed  Google Scholar 

  25. 25.

    Kalager, M., Tamimi, R.M., Bretthauer, M., Adami, H.O.: Prognosis in women with interval breast cancer: population based observational cohort study. BMJ 345, e7536 (2012)

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Barron, J.J., Quimbo, R., Nikam, P.T., Amonkar, M.M.: Assessing the economic burden of breast cancer in a US managed care population. Breast Cancer Res. Treat. 109(2), 367–377 (2008)

    Article  PubMed  Google Scholar 

  27. 27.

    Pullens, M.J., De Vries, J., Roukema, J.A.: Subjective cognitive dysfunction in breast cancer patients: a systematic review. Psychooncology 19(11), 1127–1138 (2010)

    Article  PubMed  Google Scholar 

  28. 28.

    Harrington, C.B., Hansen, J.A., Moskowitz, M., Todd, B.L., Feuerstein, M.: It’s not over when it’s over: long-term symptoms in cancer survivors–a systematic review. Int. J. Psychiatry Med. 40(2), 163–181 (2010)

    Article  PubMed  Google Scholar 

  29. 29.

    Lynge, E., Braaten, T., Njor, S.H., Olsen, A.H., Kumle, M., Waaseth, M., et al.: Mammography activity in Norway 1983–2008. Acta Oncol. 50(7), 1062–1067 (2011)

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to Dr. Ellen Schlichting (Oslo University Hospital) for providing information on common metastases of breast cancer. This project is funded by The Norwegian Research Council, Grant No. 189494.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Tron A. Moger.

Appendix: Detailed description of the cost model

Appendix: Detailed description of the cost model

Based on work by Etzioni and co-workers [28], expected breast cancer treatment costs was calculated as the mean cost incurred during a 2-month period multiplied with the probability of surviving up to, or longer than, that 2-month period:

$${\text{E}}^{D} = \mathop \sum \limits_{t} \mathop \sum \limits_{i\in D} \left[ {1 - {\text{F}}_{i}^{D} \left( t \right)} \right]{\text{E}}_{i}^{D} (t)$$

where D refers to the groups we will compare (i.e., D = 1,...,3 if the groups are screen detected, interval cancers, and non-attenders, or D = 1,...,12 if the groups are all combinations of detection mode and cancer stage). Moreover, i is the index for each combination of other covariates observed in D, hence the sum goes over all combinations of other covariates observed in the data in group D to get the marginal costs for this group. Also, t denotes the 2-month period after diagnosis (t = 1, 2…60), F D i (t) is the cumulative distribution of T for group D and combination of covariates i, 1 − F D i (t) is the probability of survival to month t for group D and combination of covariates i, and E D i (t) is the mean treatment cost incurred in the 2-month period t among those alive at the start of 2-month period t for group D and combination of covariates i. The estimator is usually known as the Kaplan–Meier sample size estimator, but in our case the survival probability was estimated by means of a Cox model as we have several covariates we wanted to include in the analysis.

Lead time bias, meaning that a cancer is detected earlier and thus treated for a longer time even though actual survival time is not increased, should be present in the data. This is irrelevant for our analysis since the outcome is expected treatment costs. In order to estimate the expected treatment costs, one has to adjust for the observed survival time, not survival adjusted for lead time bias, as it is the former that estimates the probability of being at risk for receiving treatment at a given time point.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Moger, T.A., Bjørnelv, G.M.W. & Aas, E. Expected 10-year treatment cost of breast cancer detected within and outside a public screening program in Norway. Eur J Health Econ 17, 745–754 (2016). https://doi.org/10.1007/s10198-015-0719-4

Download citation

Keywords

  • Breast cancer
  • Screening
  • Treatment costs
  • Long-term costs

JEL Classification

  • I10