Published estimates for the treatment costs of breast cancer vary widely in methodology, perspective, patient populations and time horizon. We systematically summarized and analysed the published literature on per-patient costs of breast cancer, and highlight the perspectives, populations studied, time horizons and future directions for cost studies in breast cancer.
This review included 29 US cost-of-illness studies for breast cancer. The estimates of lifetime per-patient costs of breast cancer ranged from $US20 000 to $US100 000. Payer perspectives were popular, while disease stages I and II were emphasized. The costs of initial and terminal therapy were greater than continuing care on a per-unit time basis, but continuing care accounts for the largest share of lifetime cost due to the relatively long survival of breast cancer patients. Costs of different surgeries were relatively similar (breast-conserving surgery vs mastectomy) but, all else equal, significant costs ($US23 000–31 000) were observed for patients who received adjuvant chemotherapy compared with those who did not. Multiple studies confirmed that costs increased with increased stage of disease and costs decreased with increased age of diagnosis. The question remains whether or not lower costs for elderly patients are associated with lower quality of care. The patient, employer and societal perspectives were rarely presented.
Experts in the field have recommended the societal perspective for US-based cost-effectiveness analyses. Most lifetime cost estimates were likely an underestimate for today’s lifetime cost of treating breast cancer because of changes in practice patterns and improved survival. Further societal-based cost studies that differentiate costs by stage, age and treatment time (initial, continuing and terminal), and include the latest practice patterns would be valuable toward informing US-based cost-effectiveness studies for preventive as well as breast cancer treatment interventions.
Breast Cancer Societal Perspective Breast Cancer Treatment Direct Medical Cost Lifetime Cost
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
The authors were supported by a grant from Eli Lilly and Company to perform this research. The authors wish to thank Fred Hutchinson colleagues M. Schwede, S. Taylor and S. Jones for their support in performing literature searches, gathering relevant articles and suggesting methods for synthesizing the literature. E. Meadows of Eli Lilly and Company provided suggestions on a draft manuscript. The authors have no conflicts of interest that are directly relevant to the content of this review.
Moulder S, Hortobagyi GN. Advances in the treatment of breast cancer. Clin Pharmacol Ther 2008 Jan; 83 (1): 26–36PubMedCrossRefGoogle Scholar
Radice D, Redaelli A. Breast cancer management: quality-of-life and cost considerations. Pharmacoeconomics 2003; 21 (6): 383–96PubMedCrossRefGoogle Scholar
Warren JL, Yabroff KR, Meekins A, et al. Evaluation of trends in the cost of initial cancer treatment. J Natl Cancer Inst 2008; 100 (12): 888–97PubMedCrossRefGoogle Scholar
Weinstein MC, O’Brien B, Hornberger J, et al. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices – Modeling Studies. Value Health 2003; 6 (1): 9–17PubMedCrossRefGoogle Scholar
Yabroff KR, Warren JL, Brown ML. Costs of cancer care in the USA: a descriptive review. Nat Clin Pract Oncol 2007; 4 (11): 643–56PubMedCrossRefGoogle Scholar
Gold MR, Siegal JE, Russel LB, et al., editors. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996Google Scholar
Akobundu E, Ju J, Blatt L, et al. Cost-of-illness studies: a review of current methods. Pharmacoeconomics 2006; 24 (9): 869–90PubMedCrossRefGoogle Scholar
Baker MS, Kessler LG, Urban N, et al. Estimating the treatment costs of breast and lung cancer. Med Care 1991; 29 (1): 40–9PubMedCrossRefGoogle Scholar
Taplin SH, Barlow W, Urban N, et al. Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J Natl Cancer Inst 1995; 87 (6): 417–26PubMedCrossRefGoogle Scholar
Fireman BH, Quesenberry CP, Somkin CP, et al. Cost of care for cancer in a health maintenance organization. Health Care Financ Rev 1997; 18 (4): 51–76PubMedGoogle Scholar
McDonough KL. Breast cancer stage cost analysis in a managed care population: based on a presentation. Am J Manag Care 1999 Jun; 5 (6 Suppl.): S377–82Google Scholar
Tollestrup K, Frost FJ, Stidley CA, et al. The excess costs of breast cancer health care in Hispanic and non-Hispanic female members of a managed care organization. Breast Cancer Res Treat 2001 Mar; 66 (1): 25–31PubMedCrossRefGoogle Scholar
Barlow WE, Taplin SH, Yoshida CK, et al. Cost comparison of mastectomy versus breast-conserving therapy for early-stage breast cancer. J Natl Cancer Inst 2001; 93 (6): 447–55PubMedCrossRefGoogle Scholar
Warren JL, Brown ML, Fay MP, et al. Costs of treatment for elderly women with early-stage breast cancer in fee-for-service settings. J Clin Oncol 2002; 20 (1): 307–16PubMedCrossRefGoogle Scholar
Rao S, Kubisiak J, Gilden D. Cost of illness associated with metastatic breast cancer. Breast Cancer Res Treat 2004 Jan; 83 (1): 25–32PubMedCrossRefGoogle Scholar
Oestreicher N, Ramsey SD, McCune JS, et al. The cost of adjuvant chemotherapy in patients with early-stage breast carcinoma. Cancer 2005 Nov 15; 104 (10): 2054–62PubMedCrossRefGoogle Scholar
Chirikos TN, Russell-Jacobs A, Cantor AB. Indirect economic effects of long-term breast cancer survival. Cancer Pract 2002 Sep-Oct; 10 (5): 248–55PubMedCrossRefGoogle Scholar
Sasser AC, Rousculp MD, Birnbaum HG, et al. Economic burden of osteoporosis, breast cancer, and cardiovascular disease among postmenopausal women in an employed population. Womens Health Issues 2005 May-Jun; 15 (3): 97–108PubMedCrossRefGoogle Scholar
Barnett A, Birnbaum H, Cremieux PY, et al. The costs of cancer to a major employer in the United States: a case-control analysis. Am J Manag Care 2000 Nov; 6 (11): 1243–51PubMedGoogle Scholar
Legorreta AP, Brooks RJ, Leibowitz AN, et al. Cost of breast cancer treatment: a 4-year longitudinal study. Arch Intern Med 1996 Oct 28; 156 (19): 2197–201PubMedCrossRefGoogle Scholar
Riley GF, Potosky AL, Lubitz JD, et al. Medicare payments from diagnosis to death for elderly cancer patients by stage at diagnosis. Med Care 1995; 33 (8): 828–41PubMedCrossRefGoogle Scholar
Penberthy L, Retchin SM, McDonald MK, et al. Predictors of Medicare costs in elderly beneficiaries with breast, colorectal, lung, or prostate cancer. Health Care Manag Sci 1999 Jul; 2 (3): 149–60PubMedCrossRefGoogle Scholar
Given BA, Given CW, Stommel M. Family and out-of-pocket costs for women with breast cancer. Cancer Pract 1994 May-Jun; 2 (3): 187–93PubMedGoogle Scholar
Mullins CD, Snyder SE, Wang J, et al. Economic disparities in treatment costs among ambulatory Medicaid cancer patients. J Natl Med Assoc 2004 Dec; 96 (12): 1565–74PubMedGoogle Scholar
Hensley ML, Dowell J, Herndon 2nd JE, et al. Economic outcomes of breast cancer survivorship: CALGB study 79804. Breast Cancer Res Treat 2005 May; 91 (2): 153–61PubMedCrossRefGoogle Scholar
Mandelblatt JS, Lawrence WF, Cullen J, et al. Patterns of care in early-stage breast cancer survivors in the first year after cessation of active treatment. J Clin Oncol 2006 Jan 1; 24 (1): 77–84PubMedCrossRefGoogle Scholar
Hassett MJ, O’Malley AJ, Pakes JR, et al. Frequency and cost of chemotherapy-related serious adverse effects in a population sample of women with breast cancer. J Natl Cancer Inst 2006 Aug 16; 98 (16): 1108–17PubMedCrossRefGoogle Scholar
Lamerato L, Havstad S, Gandhi S, et al. Economic burden associated with breast cancer recurrence: findings from a retrospective analysis of health system data. Cancer 2006 May 1; 106 (9): 1875–82PubMedCrossRefGoogle Scholar
Given C, Bradley C, Luca A, et al. Observation interval for evaluating the costs of surgical interventions for older women with a new diagnosis of breast cancer. Med Care 2001 Nov; 39 (11): 1146–57PubMedCrossRefGoogle Scholar
Desch CE, Penberthy LT, Hillner BE, et al. A sociodemographic and economic comparison of breast reconstruction, mastectomy, and conservative surgery. Surgery 1999 Apr; 125 (4): 441–7PubMedCrossRefGoogle Scholar
Palit TK, Miltenburg DM, Brunicardi FC. Cost analysis of breast conservation surgery compared with modified radical mastectomy with modified radical mastectomy with and without reconstruction. Am J Manag Care 2000 June 2000; 179 (6): 441–5Google Scholar
Minter RM, Spengler KK, Topping DP, et al. Institutional validation of breast cancer treatment guidelines. J Surg Res 2001 Sep; 100 (1): 106–9PubMedCrossRefGoogle Scholar
Mushinski M. Variations in charges for two major breast cancer surgeries, United States, 1996. Stat Bull Metrop Insur Co 1998 Apr-Jun; 79 (2): 24–32PubMedGoogle Scholar
Suh WW, Pierce LJ, Vicini FA, et al. A cost comparison analysis of partial versus whole-breast irradiation after breast-conserving surgery for early-stage breast cancer. Int J Radiat Oncol Biol Phys 2005 Jul 1; 62 (3): 790–6PubMedCrossRefGoogle Scholar
Arozullah AM, Calhoun EA, Wolf M, et al. The financial burden of cancer: estimates from a study of insured women with breast cancer. J Support Oncol 2004 May-Jun; 2 (3): 271–8PubMedGoogle Scholar
Gandhi SK, Arguelles L, Boyer JG. Economic impact of neutropenia and febrile neutropenia in breast cancer: estimates from two national databases. Pharmacotherapy 2001 Jun; 21 (6): 684–90PubMedCrossRefGoogle Scholar
Rahman Z, Esparza-Guerra L, Yap HY, et al. Chemotherapy-induced neutropenia and fever in patients with metastatic breast carcinoma receiving salvage chemotherapy. Cancer 1997 Mar 15; 79 (6): 1150–7PubMedCrossRefGoogle Scholar