Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing
Background: Breast cancer (BC) treatment is rapidly evolving with new and costly therapeutics. Existing costing models have a limited ability to capture current treatment costs. We used an Activity-Based Costing (ABC) method to determine a per-case cost for BC treatment by stage and molecular subtyp...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-08-01
|
| Series: | Current Oncology |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1718-7729/30/9/571 |
| _version_ | 1797580686409859072 |
|---|---|
| author | Anna N. Wilkinson Jean M. Seely Moira Rushton Phillip Williams Erin Cordeiro Alexandra Allard-Coutu Nicole J. Look Hong Nikitha Moideen Jessica Robinson Julie Renaud James G. Mainprize Martin J. Yaffe |
| author_facet | Anna N. Wilkinson Jean M. Seely Moira Rushton Phillip Williams Erin Cordeiro Alexandra Allard-Coutu Nicole J. Look Hong Nikitha Moideen Jessica Robinson Julie Renaud James G. Mainprize Martin J. Yaffe |
| author_sort | Anna N. Wilkinson |
| collection | DOAJ |
| description | Background: Breast cancer (BC) treatment is rapidly evolving with new and costly therapeutics. Existing costing models have a limited ability to capture current treatment costs. We used an Activity-Based Costing (ABC) method to determine a per-case cost for BC treatment by stage and molecular subtype. Methods: ABC was used to proportionally integrate multidisciplinary evidence-based patient and provider treatment options for BC, yielding a per-case cost for the total duration of treatment by stage and molecular subtype. Diagnostic imaging, pathology, surgery, radiation therapy, systemic therapy, inpatient, emergency, home care and palliative care costs were included. Results: BC treatment costs were higher than noted in previous studies and varied widely by molecular subtype. Cost increased exponentially with the stage of disease. The per-case cost for treatment (2023C$) for DCIS was C$ 14,505, and the mean costs for all subtypes were C$ 39,263, C$ 76,446, C$ 97,668 and C$ 370,398 for stage I, II, III and IV BC, respectively. Stage IV costs were as high as C$ 516,415 per case. When weighted by the proportion of molecular subtype in the population, case costs were C$ 31,749, C$ 66,758, C$ 111,368 and C$ 289,598 for stage I, II, III and IV BC, respectively. The magnitude of cost differential was up to 10.9 times for stage IV compared to stage I, 4.4 times for stage III compared to stage I and 35.6 times for stage IV compared to DCIS. Conclusion: The cost of BC treatment is rapidly escalating with novel therapies and increasing survival, resulting in an exponential increase in treatment costs for later-stage disease. We provide real-time, case-based costing for BC treatment which will allow for the assessment of health system economic impacts and an accurate understanding of the cost-effectiveness of screening. |
| first_indexed | 2024-03-10T22:53:27Z |
| format | Article |
| id | doaj.art-a139af6229364d7ba8fe235233275357 |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-10T22:53:27Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-a139af6229364d7ba8fe2352332753572023-11-19T10:10:39ZengMDPI AGCurrent Oncology1198-00521718-77292023-08-013097860787310.3390/curroncol30090571Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based CostingAnna N. Wilkinson0Jean M. Seely1Moira Rushton2Phillip Williams3Erin Cordeiro4Alexandra Allard-Coutu5Nicole J. Look Hong6Nikitha Moideen7Jessica Robinson8Julie Renaud9James G. Mainprize10Martin J. Yaffe11Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, CanadaDepartment of Radiology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, CanadaThe Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, CanadaDivision of Anatomic Pathology, The Ottawa Hospital, 501 Smyth Rd., Ottawa, ON K1H 8L6, CanadaDivision of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON K1H 8L6, CanadaDivision of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON K1H 8L6, CanadaDepartment of Surgery, University of Toronto, Toronto, ON M5T 1P5, CanadaThe Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, CanadaThe Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, CanadaThe Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, CanadaDepartment of Medical Biophysics, University of Toronto, Toronto, ON M4N 3M5, CanadaDepartment of Medical Biophysics, University of Toronto, Toronto, ON M4N 3M5, CanadaBackground: Breast cancer (BC) treatment is rapidly evolving with new and costly therapeutics. Existing costing models have a limited ability to capture current treatment costs. We used an Activity-Based Costing (ABC) method to determine a per-case cost for BC treatment by stage and molecular subtype. Methods: ABC was used to proportionally integrate multidisciplinary evidence-based patient and provider treatment options for BC, yielding a per-case cost for the total duration of treatment by stage and molecular subtype. Diagnostic imaging, pathology, surgery, radiation therapy, systemic therapy, inpatient, emergency, home care and palliative care costs were included. Results: BC treatment costs were higher than noted in previous studies and varied widely by molecular subtype. Cost increased exponentially with the stage of disease. The per-case cost for treatment (2023C$) for DCIS was C$ 14,505, and the mean costs for all subtypes were C$ 39,263, C$ 76,446, C$ 97,668 and C$ 370,398 for stage I, II, III and IV BC, respectively. Stage IV costs were as high as C$ 516,415 per case. When weighted by the proportion of molecular subtype in the population, case costs were C$ 31,749, C$ 66,758, C$ 111,368 and C$ 289,598 for stage I, II, III and IV BC, respectively. The magnitude of cost differential was up to 10.9 times for stage IV compared to stage I, 4.4 times for stage III compared to stage I and 35.6 times for stage IV compared to DCIS. Conclusion: The cost of BC treatment is rapidly escalating with novel therapies and increasing survival, resulting in an exponential increase in treatment costs for later-stage disease. We provide real-time, case-based costing for BC treatment which will allow for the assessment of health system economic impacts and an accurate understanding of the cost-effectiveness of screening.https://www.mdpi.com/1718-7729/30/9/571breast cancertreatmenthealth economicsactivity-based costing |
| spellingShingle | Anna N. Wilkinson Jean M. Seely Moira Rushton Phillip Williams Erin Cordeiro Alexandra Allard-Coutu Nicole J. Look Hong Nikitha Moideen Jessica Robinson Julie Renaud James G. Mainprize Martin J. Yaffe Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing Current Oncology breast cancer treatment health economics activity-based costing |
| title | Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing |
| title_full | Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing |
| title_fullStr | Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing |
| title_full_unstemmed | Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing |
| title_short | Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing |
| title_sort | capturing the true cost of breast cancer treatment molecular subtype and stage specific per case activity based costing |
| topic | breast cancer treatment health economics activity-based costing |
| url | https://www.mdpi.com/1718-7729/30/9/571 |
| work_keys_str_mv | AT annanwilkinson capturingthetruecostofbreastcancertreatmentmolecularsubtypeandstagespecificpercaseactivitybasedcosting AT jeanmseely capturingthetruecostofbreastcancertreatmentmolecularsubtypeandstagespecificpercaseactivitybasedcosting AT moirarushton capturingthetruecostofbreastcancertreatmentmolecularsubtypeandstagespecificpercaseactivitybasedcosting AT phillipwilliams capturingthetruecostofbreastcancertreatmentmolecularsubtypeandstagespecificpercaseactivitybasedcosting AT erincordeiro capturingthetruecostofbreastcancertreatmentmolecularsubtypeandstagespecificpercaseactivitybasedcosting AT alexandraallardcoutu capturingthetruecostofbreastcancertreatmentmolecularsubtypeandstagespecificpercaseactivitybasedcosting AT nicolejlookhong capturingthetruecostofbreastcancertreatmentmolecularsubtypeandstagespecificpercaseactivitybasedcosting AT nikithamoideen capturingthetruecostofbreastcancertreatmentmolecularsubtypeandstagespecificpercaseactivitybasedcosting AT jessicarobinson capturingthetruecostofbreastcancertreatmentmolecularsubtypeandstagespecificpercaseactivitybasedcosting AT julierenaud capturingthetruecostofbreastcancertreatmentmolecularsubtypeandstagespecificpercaseactivitybasedcosting AT jamesgmainprize capturingthetruecostofbreastcancertreatmentmolecularsubtypeandstagespecificpercaseactivitybasedcosting AT martinjyaffe capturingthetruecostofbreastcancertreatmentmolecularsubtypeandstagespecificpercaseactivitybasedcosting |