Diagnostic and therapeutic approaches for nonmetastatic breast cancer in Canada, and their associated costs

an era of fiscal restraint, it is important to evaluate the resources requi red to diagnose and treat serious illnesses. As breast cancer is the major malignancy affecting Canadian women, Statistics Canada has analysed the res ources required to manage this disease in Canada, and the associated costs. Here we report the cost of initial diagnosis and treatment of nonmetastati c breast cancer, including adjuvant therapies. Treatment algorithms for Sta ges I, II, and III of the disease were derived by age group (< 50 or greate r than or equal to 50 years old), principally from Canadian cancer registry data, supplemented, where necessary, by the results of surveys of Canadian oncologists. Data were obtained on breast cancer incidence by age, diagnos tic work-up, stage at diagnosis, initial treatment, follow-up practice, dur ation of hospitalization and direct care costs. The direct health care cost s associated with 'standard' diagnostic and therapeutic approaches were cal culated for a cohort of 17 700 Canadian women diagnosed in 1995. Early stag e (Stages I and II) breast cancer represented 87% of all incident cases, wi th 77% of cases occurring in women greater than or equal to 50 years. Varia tions were noted in the rate of partial vs total mastectomy, according to s tage and age group. Direct costs for diagnosis and initial treatment ranged from $8014 for Stage II women greater than or equal to 50 years old, to $1 0 897 for Stage III women < 50 years old. Except for Stage III women < 50 y ears old, the largest expenditure was for hospitalization for surgery, foll owed by radiotherapy costs. Chemotherapy was the largest cost component for Stage ill women < 50 years old. This report describes the cost of diagnosi s and initial treatment of nonmetastatic breast cancer in Canada, assuming current practice patterns. A second report will describe the lifetime costs of treating all stages of breast cancer. These data will then be incorpora ted into Statistics Canada's Population Health Model (POHEM) to perform cos t-effectiveness studies of new therapeutic interventions for breast cancer, such as the cost-effectiveness of day surgery, or of radiotherapy to all b reast cancer patients undergoing breast surgery.